MEDICARE: DR. BRUCE H LYNN 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	207N00000X	Dermatology Physician	35772	AZ
2	207ND0101X	MOHS-Micrographic Surgery Physician	35772	AZ

General Provider Information

NPI Number	:	1609858893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE H LYNN MD

Provider Business Mailing Address
First Line	:	6640 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2119
Country	:	US
Telephone Number	:	520-886-4199
Fax Number	:	520-886-3114

Provider Business Practice Location Address
First Line	:	6640 E CARONDELET DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-2119
Country	:	US
Telephone Number	:	520-886-4199
Fax Number	:	520-886-3114

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	02/25/2008

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