Basic Information
| Provider Information | |||||||||
| NPI: | 1952668071 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOAN | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | TYSON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4351 E LOHMAN AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | LAS CRUCES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880118262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5755329755 | ||||||||
| FaxNumber: | 5755568998 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 MARKETPLACE PLZ STE 200 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804871841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708796663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2012 | ||||||||
| LastUpdateDate: | 11/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | A-1971-16 | NM | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.