Provider Demographics
NPI:1740338433
Name:LYONGA, JULIUS (PA)
Entity type:Individual
Prefix:
First Name:JULIUS
Middle Name:
Last Name:LYONGA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79416-3111
Mailing Address - Country:US
Mailing Address - Phone:806-797-4985
Mailing Address - Fax:806-744-7545
Practice Address - Street 1:301 UTICA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79416-3111
Practice Address - Country:US
Practice Address - Phone:806-797-4985
Practice Address - Fax:806-744-7545
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA05106363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant