MEDICARE: DR. LYNN MITCHELL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15345	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154580306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYNN MITCHELL M.D.

Provider Business Mailing Address
First Line	:	4545 N LINCOLN BLVD
Second Line	:	SUITE 124
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-3418
Country	:	US
Telephone Number	:	405-522-7365
Fax Number	:	405-530-3218

Provider Business Practice Location Address
First Line	:	4545 N LINCOLN BLVD
Second Line	:	SUITE 124
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73105-3418
Country	:	US
Telephone Number	:	405-522-7365
Fax Number	:	405-530-3218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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