Provider Demographics
NPI:1588867535
Name:SPITLER, LYNN E (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:E
Last Name:SPITLER
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 1:547 VIRGINA DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920
Mailing Address - Country:US
Mailing Address - Phone:415-435-9861
Mailing Address - Fax:415-435-6851
Practice Address - Street 1:450 STANYAN ST
Practice Address - Street 2:NORTHER CALIFORNIA MELANOMA CENTER ST. MARY'S MED CENTE
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1019
Practice Address - Country:US
Practice Address - Phone:415-750-5660
Practice Address - Fax:415-750-4860
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2010-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC26446207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C264460Medicaid
CA00C264460Medicare ID - Type UnspecifiedMEDICARE
CA00C264460Medicaid