Healthcare Provider Details

I. General information

NPI: 1871804369
Provider Name (Legal Business Name): ANDREW LYONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 HIGHLAND BLVD
BOZEMAN MT
59715-6900
US

IV. Provider business mailing address

PO BOX 84891
SEATTLE WA
98124-6191
US

V. Phone/Fax

Practice location:
  • Phone: 406-582-4963
  • Fax:
Mailing address:
  • Phone: 425-407-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA137915
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberRS2010-331
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number51315
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: