Healthcare Provider Details

I. General information

NPI: 1982765186
Provider Name (Legal Business Name): LYNN VIX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER STREET
KEESLER AFB MS
39534
US

IV. Provider business mailing address

425 DONWOOD PL
BILOXI MS
39530-1617
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-6668
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number20902
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: