MEDICARE: LYNDELL D SCOLES 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	207R00000X	Internal Medicine Physician	R6P51	MO

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	:	1689676231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDELL D SCOLES MD

Provider Business Mailing Address
First Line	:	1605 E BROADWAY
Second Line	:	STE 280
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8023
Country	:	US
Telephone Number	:	573-815-8155
Fax Number	:	573-815-8154

Provider Business Practice Location Address
First Line	:	1605 E BROADWAY
Second Line	:	STE 280
City	:	COLUMBIA
State	:	MO
Zip	:	65201-8023
Country	:	US
Telephone Number	:	573-815-8155
Fax Number	:	573-815-8154

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/30/2019

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