Provider Demographics
NPI:1326003559
Name:LYNN, BECKY KAUFMAN (MD)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:KAUFMAN
Last Name:LYNN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:A
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6420 CLAYTON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-781-1031
Mailing Address - Fax:314-781-2840
Practice Address - Street 1:1031 BELLEVUE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1818
Practice Address - Country:US
Practice Address - Phone:314-977-7455
Practice Address - Fax:314-977-7477
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003009736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5483481OtherCCN
611601OtherHEALTHLINK
P00039844OtherRR MEDICARE
179880OtherBLUE CROSS BLUE SHIELD
MO208401208Medicaid
440546366OtherHUMANA
2139540OtherFIRST HEALTH
MO208401208Medicaid
179880OtherBLUE CROSS BLUE SHIELD
H90838Medicare UPIN