Provider Demographics
NPI:1770582306
Name:SHIPMAN, LYNN P (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:P
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:P
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2218 VIA TESORO
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3162
Mailing Address - Country:US
Mailing Address - Phone:858-451-3311
Mailing Address - Fax:858-451-1142
Practice Address - Street 1:15525 POMERADO RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2435
Practice Address - Country:US
Practice Address - Phone:858-451-3311
Practice Address - Fax:858-451-1142
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52015174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA66964Medicare UPIN
CAWG52015AMedicare ID - Type Unspecified