Healthcare Provider Details

I. General information

NPI: 1609858893
Provider Name (Legal Business Name): BRUCE H LYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 E CARONDELET DR
TUCSON AZ
85710-2119
US

IV. Provider business mailing address

6640 E CARONDELET DR
TUCSON AZ
85710-2119
US

V. Phone/Fax

Practice location:
  • Phone: 520-886-4199
  • Fax: 520-886-3114
Mailing address:
  • Phone: 520-886-4199
  • Fax: 520-886-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35772
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number35772
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: