MEDICARE: MRS. LYNN ANN MAAROUF RD,LD,CDE

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	133V00000X	Registered Dietitian	DT06378	TX

General Provider Information

NPI Number	:	1558423947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNN ANN MAAROUF RD,LD,CDE

Provider Business Mailing Address
First Line	:	UNIVERSITY OF TEXAS MEDICAL BR
Second Line	:	301 UNIVERSITY BLVD
City	:	GALVESTON
State	:	TX
Zip	:	77555-1090
Country	:	US
Telephone Number	:	409-539-8404
Fax Number	:	281-338-0805

Provider Business Practice Location Address
First Line	:	2660 GULF FWY S
Second Line	:	STARK DIABETES CENTER SUITE # 9
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6820
Country	:	US
Telephone Number	:	409-539-8404
Fax Number	:	281-337-0805

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	08/30/2012

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