Provider Demographics
NPI:1245397397
Name:TUCKER, LYNN Z (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:Z
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LYNN
Other - Middle Name:
Other - Last Name:MYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7388 HIGHLAND RD
Mailing Address - Street 2:STE. A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-6601
Mailing Address - Country:US
Mailing Address - Phone:225-766-2132
Mailing Address - Fax:225-766-2169
Practice Address - Street 1:7388 HIGHLAND RD
Practice Address - Street 2:STE. A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-6601
Practice Address - Country:US
Practice Address - Phone:225-766-2132
Practice Address - Fax:225-766-2169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9687207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAD84469Medicare UPIN