Provider Demographics
NPI:1285898668
Name:SCANLAN, LYNNE (DO)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:SCANLAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 LOU HOLLOW PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-3103
Mailing Address - Country:US
Mailing Address - Phone:512-484-8897
Mailing Address - Fax:
Practice Address - Street 1:2409 LOU HOLLOW PL
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3103
Practice Address - Country:US
Practice Address - Phone:512-484-8897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017880207Q00000X
TXN9294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB132636Medicare PIN