Provider Demographics
NPI:1124076161
Name:ANDERSON, LYNN A (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:ANDERSON
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 1:2424 E 21ST ST STE 340
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-1722
Mailing Address - Country:US
Mailing Address - Phone:918-743-4046
Mailing Address - Fax:918-728-3376
Practice Address - Street 1:2424 E 21ST ST STE 340
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1722
Practice Address - Country:US
Practice Address - Phone:918-728-3100
Practice Address - Fax:918-728-3376
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18895207NP0225X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
070015382OtherRAILROAD MEDICARE - PALMETTO GBA
OKA13163Medicare UPIN