Provider Demographics
NPI:1033107453
Name:COLUMBUS, LYNNE CARR (DO)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:CARR
Last Name:COLUMBUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 EASTLAND BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4104
Mailing Address - Country:US
Mailing Address - Phone:727-789-0891
Mailing Address - Fax:727-789-1570
Practice Address - Street 1:3001 EASTLAND BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4104
Practice Address - Country:US
Practice Address - Phone:727-789-0891
Practice Address - Fax:727-789-1570
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6713207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050067680OtherRAILROAD MEDICARE
FL80961OtherBLUE SHIELD
FL050067680OtherRAILROAD MEDICARE
FL80961OtherBLUE SHIELD