MEDICARE: JEFFERY R LYNN

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	146M00000X	Intermediate Emergency Medical Technician	084500	TX

General Provider Information

NPI Number	:	1811134265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY R LYNN

Provider Business Mailing Address
First Line	:	8907 ENDICOTT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2711
Country	:	US
Telephone Number	:	281-333-4252
Fax Number	:	281-333-4269

Provider Business Practice Location Address
First Line	:	8907 ENDICOTT LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77096-2711
Country	:	US
Telephone Number	:	281-333-4252
Fax Number	:	281-333-4269

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

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	01/07/2009

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