1558304766 NPI number — DR. MARTIN S LYNN D.P.M.

Table of content: DR. MARTIN S LYNN D.P.M. (NPI 1558304766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558304766 NPI number — DR. MARTIN S LYNN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNN
Provider First Name:
MARTIN
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558304766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1429 AVENUE D
Provider Second Line Business Mailing Address:
#293
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98290-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-355-3701
Provider Business Mailing Address Fax Number:
206-577-2931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1429 AVENUE D
Provider Second Line Business Practice Location Address:
#293
Provider Business Practice Location Address City Name:
SNOHOMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98290-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-355-3701
Provider Business Practice Location Address Fax Number:
206-577-2931
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO446 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50387 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1085711 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com