MEDICARE: DR. LINDA SUE LACY 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	207VG0400X	Gynecology Physician	H5251	TX

General Provider Information

NPI Number	:	1275504227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA SUE LACY M.D.

Provider Business Mailing Address
First Line	:	7430 REMCON CIR
Second Line	:	BUILDING B, SUITE 100
City	:	EL PASO
State	:	TX
Zip	:	79912-3514
Country	:	US
Telephone Number	:	915-541-1144
Fax Number	:	915-541-1170

Provider Business Practice Location Address
First Line	:	7430 REMCON CIR
Second Line	:	BUILDING B, SUITE 100
City	:	EL PASO
State	:	TX
Zip	:	79912-3514
Country	:	US
Telephone Number	:	915-541-1144
Fax Number	:	915-541-1170

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

Provider Enumeration Date	:	01/29/2006
Last Update Date	:	10/27/2014

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