Healthcare Provider Details

I. General information

NPI: 1568561397
Provider Name (Legal Business Name): LYNNE MARIE KNOWLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6204 BALCONES DR
AUSTIN TX
78731-4214
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 512-302-1771
  • Fax: 512-302-9774
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-437-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberL7779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: