Provider Demographics
NPI:1043557358
Name:LYNN CASEY BOYSEL, D.O. PLLC.
Entity Type:Organization
Organization Name:LYNN CASEY BOYSEL, D.O. PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNN CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:520-333-5963
Mailing Address - Street 1:PO BOX 65375
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85728-5375
Mailing Address - Country:US
Mailing Address - Phone:520-333-5963
Mailing Address - Fax:520-326-0142
Practice Address - Street 1:1921 W HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7806
Practice Address - Country:US
Practice Address - Phone:520-333-5963
Practice Address - Fax:520-326-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4393208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZK21248Medicare PIN