Healthcare Provider Details

I. General information

NPI: 1205964285
Provider Name (Legal Business Name): LYNN E. SPITLER, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN STREET ST. MARY'S MEDICAL CENTER, NORTHERN CALIFORNIA MELANOMA
SAN FRANCISCO CA
94117-2725
US

IV. Provider business mailing address

1895 MOUNTAIN VIEW DRIVE
TIBURON CA
94920-1809
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC26446
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberC26446
License Number StateCA

VIII. Authorized Official

Name: DR. LYNN E. SPITLER
Title or Position: PRESIDENT
Credential: MD
Phone: 415-750-4020