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NPI Code Detail

MEDICARE: DR. LARRY WADE LYNN M.D.

MEDICARE: DR. LARRY WADE LYNN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician01037887AIN
2208000000XPediatrics Physician01037887IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P01456893OTHERINMEDICARE RAILROAD PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396879292
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY WADE LYNN M.D.
Provider Business Mailing Address
First Line : 4055 VALLEY VIEW LN STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75244-5045
Country : US
Telephone Number : 855-984-5121
Fax Number :
Provider Business Practice Location Address
First Line : 4055 VALLEY VIEW LN STE 700
Second Line :
City : DALLAS
State : TX
Zip : 75244-5045
Country : US
Telephone Number : 855-984-5121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 07/06/2023

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