Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 28548 | MN |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 28548 | MN |
NPI | 1356303242 |
---|---|
Provider Name | John A Lynch |
First Address | Saint Paul, MN 55114-1451 |
Second Address | Coon Rapids, MN 55433-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
483382100 | (05) | MN |
D79983 | (02) |