Provider Demographics
NPI:1548262397
Name:LYONS, MARTIN BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:BRADLEY
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 SAWYER DR
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81303-6560
Mailing Address - Country:US
Mailing Address - Phone:970-259-3110
Mailing Address - Fax:970-259-6605
Practice Address - Street 1:316 SAWYER DR
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6560
Practice Address - Country:US
Practice Address - Phone:970-259-3110
Practice Address - Fax:970-259-6605
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33763207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF88807Medicare UPIN
CO806128Medicare PIN
L0278Medicare ID - Type Unspecified
CO806128Medicare PIN