MEDICARE: MR. JERRY DOUGLAS LYNCH PA

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	363A00000X	Physician Assistant	PA00276	TX

General Provider Information

NPI Number	:	1962630749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY DOUGLAS LYNCH PA

Provider Business Mailing Address
First Line	:	6340 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-4038
Country	:	US
Telephone Number	:	361-854-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3845 S PADRE ISLAND DR
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2919
Country	:	US
Telephone Number	:	361-854-4626
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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