Provider Demographics
NPI:1629035282
Name:WURTS, LYNNE (MD)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:WURTS
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 1:10611 GARLAND RD STE 210
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-2695
Mailing Address - Country:US
Mailing Address - Phone:214-324-2881
Mailing Address - Fax:214-328-4084
Practice Address - Street 1:10611 GARLAND RD STE 210
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-2695
Practice Address - Country:US
Practice Address - Phone:214-324-2881
Practice Address - Fax:214-328-4084
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4068207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141168801Medicaid
TX8609M6Medicare ID - Type Unspecified
B23444Medicare UPIN