Healthcare Provider Details

I. General information

NPI: 1912376914
Provider Name (Legal Business Name): BRIAN MICHAEL LYNDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2015
Last Update Date: 09/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N PORTER AVE
NORMAN OK
73071-6404
US

IV. Provider business mailing address

144 N ALDER ST
COLVILLE WA
99114-3220
US

V. Phone/Fax

Practice location:
  • Phone: 405-307-1000
  • Fax:
Mailing address:
  • Phone: 509-690-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0072R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: