Healthcare Provider Details

I. General information

NPI: 1477544583
Provider Name (Legal Business Name): JOHN CORNELIUS LYONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 W 12TH ST
ERIE PA
16505-4508
US

IV. Provider business mailing address

2152 S SHORE DR
ERIE PA
16505-2248
US

V. Phone/Fax

Practice location:
  • Phone: 814-455-2170
  • Fax: 814-455-9119
Mailing address:
  • Phone: 814-455-2170
  • Fax: 814-455-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD025800E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: