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General NPI Number Information
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NPI Number | 1720117542
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Entity Type | Individual
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Provider Name | LYNN ALLAN ROBERSON LMT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 BRECKENRIDGE LN
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City | LOUISVILLE
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State | KY
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Zip | 40207-3859
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Country | US
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Telephone | 502-386-1625
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Fax |
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Provider Business Mailing Address
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Address Line | 622 WATAGA DR
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City | LOUISVILLE
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State | KY
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Zip | 40206-2839
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Country | US
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Telephone | 502-386-1625
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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 | KY-0103
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License Number State | KY
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