Provider Demographics
NPI:1609858893
Name:LYNN, BRUCE H (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:LYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6640 E CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2119
Mailing Address - Country:US
Mailing Address - Phone:520-886-4199
Mailing Address - Fax:520-886-3114
Practice Address - Street 1:6640 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-886-4199
Practice Address - Fax:520-886-3114
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35772207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E12166Medicare UPIN
AZ111221Medicare PIN