Healthcare Provider Details

I. General information

NPI: 1295231256
Provider Name (Legal Business Name): JOSHUA DANIEL LYON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 04/11/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 AUTUMN ROAD SUITE 100
LITTLE ROCK AR
72211
US

IV. Provider business mailing address

2920 MOSSY CREEK DR
LITTLE ROCK AR
72211-4450
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-5437
  • Fax:
Mailing address:
  • Phone: 501-749-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-13153
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: