Healthcare Provider Details

I. General information

NPI: 1811194673
Provider Name (Legal Business Name): EDWARD JOSEPH LYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N DIVISION ST
CARSON CITY NV
89703-4102
US

IV. Provider business mailing address

411 N DIVISION ST
CARSON CITY NV
89703-4102
US

V. Phone/Fax

Practice location:
  • Phone: 775-882-7770
  • Fax: 775-882-7294
Mailing address:
  • Phone: 775-882-7770
  • Fax: 775-882-7294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number3070
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: