Healthcare Provider Details

I. General information

NPI: 1841879335
Provider Name (Legal Business Name): ELIZABETH LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 11/08/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CROWNPOINT HEALTHCARE FACILITY JUNCTION RD. 371 ROUTE 9
CROWNPOINT NM
87313
US

IV. Provider business mailing address

PO BOX 358
CROWNPOINT NM
87313-0358
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2111
  • Fax:
Mailing address:
  • Phone: 505-786-6302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2024-0216
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: