MEDICARE: LEANDRA LYNCH MD

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	208D00000X	General Practice Physician	35452	CO
2	207P00000X	Emergency Medicine Physician	46452	AZ

General Provider Information

NPI Number	:	1386647766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANDRA LYNCH MD

Provider Business Mailing Address
First Line	:	9455 E DESERT COVE AVE
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-6161
Country	:	US
Telephone Number	:	970-209-5910
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 N WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711
Country	:	US
Telephone Number	:	520-873-2770
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/14/2019

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