Healthcare Provider Details

I. General information

NPI: 1588867535
Provider Name (Legal Business Name): LYNN E. SPITLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST NORTHER CALIFORNIA MELANOMA CENTER ST. MARY'S MED CENTE
SAN FRANCISCO CA
94117-1019
US

IV. Provider business mailing address

547 VIRGINA DR
TIBURON CA
94920
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5660
  • Fax: 415-750-4860
Mailing address:
  • Phone: 415-435-9861
  • Fax: 415-435-6851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberC26446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: