Healthcare Provider Details

I. General information

NPI: 1922054659
Provider Name (Legal Business Name): LYNN NORMAN CARLTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH ROAD
WARRENSBURG MO
64093
US

IV. Provider business mailing address

5157 S CASTLEWOOD DR
SPRINGFIELD MO
65804-7708
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2500
  • Fax: 660-747-8455
Mailing address:
  • Phone: 417-883-9805
  • Fax: 417-883-4829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberE-3641
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: