MEDICARE: DR. JAMIE LYNN LYNCH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	P4344	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8KJ487	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1053577882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE LYNN LYNCH M.D.

Provider Business Mailing Address
First Line	:	ID# 2163
Second Line	:	PO BOX 659506
City	:	SAN ANTONIO
State	:	TX
Zip	:	78265-9506
Country	:	US
Telephone Number	:	210-878-4116
Fax Number	:	210-878-4113

Provider Business Practice Location Address
First Line	:	18626 HARDY OAK BLVD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4218
Country	:	US
Telephone Number	:	210-878-4116
Fax Number	:	210-878-4113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	05/19/2020

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