MEDICARE: LYNN W COLLINS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD00044822	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801892112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN W COLLINS MD

Provider Business Mailing Address
First Line	:	1 BOONE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	425-304-4138
Fax Number	:	425-304-4082

Provider Business Practice Location Address
First Line	:	1 BOONE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-1894
Country	:	US
Telephone Number	:	425-304-4138
Fax Number	:	425-304-4082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	03/29/2012

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