Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 30482 | AZ |
NPI | 1477540292 |
---|---|
Provider Name | Christopher L Lykins |
First Address | Scottsdale, AZ 85255-4134 |
Second Address | Scottsdale, AZ 85255-4134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 15/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
776859 | (05) | AZ |
AZ0779400 | BLUE CROSS BLUE SHIELD (01) | AZ |
H49827 | (02) | |
P00452180 | MEDICARE RAILROAD (01) | AZ |