Healthcare Provider Details

I. General information

NPI: 1376957670
Provider Name (Legal Business Name): STEPHANIE LYNCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 RAYFORD RD STE 100
SPRING TX
77386-4364
US

IV. Provider business mailing address

3515 RAYFORD RD STE 100
SPRING TX
77386-4364
US

V. Phone/Fax

Practice location:
  • Phone: 281-350-7040
  • Fax: 281-350-1636
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR4268
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: