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Individual
MR. ROBERT LEE LYCKSELL
Active
Individual
MR. ROBERT LEE LYCKSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00020054
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05867
BLUE CROSS/SHIELD
WA
01
—
080037635
RAILROAD MEDICARE
—
01
—
G001148103
MEDICARE PTAN
WA
Enumeration date
12/29/2005
Last updated
02/21/2011
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