Healthcare Provider Details

I. General information

NPI: 1902863301
Provider Name (Legal Business Name): LINDA CARRADINE LYNCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 08/21/2007

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-2199
US

IV. Provider business mailing address

PO BOX DD
TAOS NM
87571-2199
US

V. Phone/Fax

Practice location:
  • Phone: 505-758-8883
  • Fax: 505-751-5705
Mailing address:
  • Phone: 505-758-8883
  • Fax: 505-751-5718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number93-84
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: