Healthcare Provider Details

I. General information

NPI: 1801895180
Provider Name (Legal Business Name): LINCOLN MACKEY SNYDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE SUITE 200 G
NEWPORT BEACH CA
92663-3663
US

IV. Provider business mailing address

510 SUPERIOR AVE SUITE 200 G
NEWPORT BEACH CA
92663-3663
US

V. Phone/Fax

Practice location:
  • Phone: 949-791-6767
  • Fax: 949-791-6768
Mailing address:
  • Phone: 949-791-6767
  • Fax: 949-791-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG56505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG56505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: