Basic Information
| Provider Information | |||||||||
| NPI: | 1326003559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYNN | ||||||||
| FirstName: | BECKY | ||||||||
| MiddleName: | KAUFMAN | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KAUFMAN | ||||||||
| OtherFirstName: | BECKY | ||||||||
| OtherMiddleName: | A | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147811031 | ||||||||
| FaxNumber: | 3147812840 | ||||||||
| Practice Location | |||||||||
| Address1: | 1031 BELLEVUE AVE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149777455 | ||||||||
| FaxNumber: | 3149777477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 08/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2003009736 | MO | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 5483481 | 01 | CCN | OTHER | 611601 | 01 | HEALTHLINK | OTHER | P00039844 | 01 | RR MEDICARE | OTHER | 179880 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 208401208 | 05 | MO | MEDICAID | 440546366 | 01 | HUMANA | OTHER | 2139540 | 01 | FIRST HEALTH | OTHER |