Provider Demographics
NPI:1023008034
Name:LYNCH, GAYLENE FAYE (DO)
Entity Type:Individual
Prefix:DR
First Name:GAYLENE
Middle Name:FAYE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 RIVER VISTA DR
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-1050
Mailing Address - Country:US
Mailing Address - Phone:515-283-1360
Mailing Address - Fax:515-246-8340
Practice Address - Street 1:802 KENYON RD
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5740
Practice Address - Country:US
Practice Address - Phone:515-574-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1849207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA31549OtherWELLMARK OF IOWA
IA5206888Medicaid
IA54683OtherMEDICARE GROUP NUMBER
IA5206888Medicaid
IAI8140Medicare PIN