Healthcare Provider Details

I. General information

NPI: 1679565162
Provider Name (Legal Business Name): JOHN P LYNCH MD, MPH, FAAFP, CPE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 840, AREA B, 2510 FIFTH STREET USAFSAM/FEC
WPAFB OH
45433-7913
US

IV. Provider business mailing address

730 PEARSON RD
WPAFB OH
45433-1161
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-3097
  • Fax:
Mailing address:
  • Phone: 808-260-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number19050
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: