MEDICARE: LYNZEE CHRISTINE BUNTYN PA-C

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	363A00000X	Physician Assistant	1905	OK
2	363A00000X	Physician Assistant	PA08416	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1905	OTHER	OK	PA NUMBER

General Provider Information

NPI Number	:	1821310947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNZEE CHRISTINE BUNTYN PA-C

Provider Business Mailing Address
First Line	:	2925 GULF FWY S STE B390
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-6768
Country	:	US
Telephone Number	:	281-335-4000
Fax Number	:	281-335-4004

Provider Business Practice Location Address
First Line	:	1110 NASA PKWY STE 620
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3360
Country	:	US
Telephone Number	:	281-335-4000
Fax Number	:	281-335-4004

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

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	09/21/2023

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