Provider Demographics
NPI:1922085901
Name:LYCKSELL, ROBERT LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:LYCKSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:231 SE BARRINGTON DRIVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277
Mailing Address - Country:US
Mailing Address - Phone:360-679-3161
Mailing Address - Fax:360-679-1741
Practice Address - Street 1:231 SE BARRINGTON DRIVE
Practice Address - Street 2:SUITE 209
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277
Practice Address - Country:US
Practice Address - Phone:360-679-3161
Practice Address - Fax:360-679-1741
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00020054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080037635OtherRAILROAD MEDICARE
WA05867OtherBLUE CROSS/SHIELD
WAG001148103OtherMEDICARE PTAN
WA001148103Medicare PIN