Provider Demographics
NPI:1780730309
Name:GRIES, LYNN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:GRIES
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:UNIVERSITY OF ARIZONA
Mailing Address - Street 2:P.O. BOX 245063
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5063
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF ARIZONA
Practice Address - Street 2:1501 N. CAMPBELL AVE. RM 5411
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5063
Practice Address - Country:US
Practice Address - Phone:520-626-0478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ449802086S0127X
COTL-455390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery