Healthcare Provider Details

I. General information

NPI: 1194839217
Provider Name (Legal Business Name): JOHN C. LINCOLN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 N 3RD ST SUITE 307
PHOENIX AZ
85020-2439
US

IV. Provider business mailing address

PO BOX 9907
PHOENIX AZ
85068-0907
US

V. Phone/Fax

Practice location:
  • Phone: 602-249-2490
  • Fax: 602-249-2555
Mailing address:
  • Phone: 602-249-2490
  • Fax: 602-249-2555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY GROVER
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 623-516-8637