Provider Demographics
NPI:1457331993
Name:SAMUELS, LYNN ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ELLEN
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4940 N CAMINO ESPLENDORA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6223
Mailing Address - Country:US
Mailing Address - Phone:520-299-2209
Mailing Address - Fax:520-299-0289
Practice Address - Street 1:4940 N CAMINO ESPLENDORA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6223
Practice Address - Country:US
Practice Address - Phone:520-299-2209
Practice Address - Fax:520-299-0289
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine