Healthcare Provider Details

I. General information

NPI: 1821392564
Provider Name (Legal Business Name): LYNN ELIZABETH LYTTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S MAIN ST FAMILY MEDICINE DEPARTMENT, 4TH FLOOR
FORT WORTH TX
76104-4917
US

IV. Provider business mailing address

1500 SOUTH MAIN ST. FAMILY MEDICINE DEPARTMENT, 4TH FLOOR
FORT WORTH TX
76104
US

V. Phone/Fax

Practice location:
  • Phone: 817-927-1365
  • Fax:
Mailing address:
  • Phone: 817-927-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberN8419
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: