Healthcare Provider Details

I. General information

NPI: 1922025931
Provider Name (Legal Business Name): LYNN JAMES GROOME M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF OB/GYN
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF OB/GYN
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-8700
  • Fax: 318-675-8706
Mailing address:
  • Phone: 318-675-8700
  • Fax: 318-675-8706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number018476
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: