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General NPI Number Information
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NPI Number | 1497703607
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Entity Type | Individual
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Provider Name | LYNN BEAULIEU MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 175 S UNION BLVD SUITE 305
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3113
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Country | US
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Telephone | 719-365-6881
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Fax | 719-365-6877
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Provider Business Mailing Address
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Address Line | 4199 APACHE PLUME DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7664
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Country | US
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Telephone | 719-282-4321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31824
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License Number State | CO
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