Healthcare Provider Details

I. General information

NPI: 1558429522
Provider Name (Legal Business Name): MATTHEW ROBERT LYONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 NW 11TH ST STE M201
HERMISTON OR
97838-6941
US

IV. Provider business mailing address

620 NW 11TH ST STE M201
HERMISTON OR
97838-6941
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3771
  • Fax: 541-303-8457
Mailing address:
  • Phone: 541-667-3771
  • Fax: 541-303-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number49770
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD226859
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number22491
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: