Provider Demographics
NPI:1346289386
Name:BOYSEL, LYNN C (DO)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:BOYSEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:BOYSEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
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 1:2650 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6106
Practice Address - Country:US
Practice Address - Phone:520-333-5963
Practice Address - Fax:520-326-0142
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4393208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ147921OtherMEDICARE PTAN
AZZ147921OtherMEDICARE PTAN
AZK21248Medicare UPIN
AZZ147280Medicare PIN