Provider Demographics
NPI:1033219076
Name:LYN, PETER OWEN (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:OWEN
Last Name:LYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 E INDIANTOWN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-5188
Mailing Address - Country:US
Mailing Address - Phone:561-741-5566
Mailing Address - Fax:561-295-5237
Practice Address - Street 1:1080 E INDIANTOWN RD STE 206
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-5188
Practice Address - Country:US
Practice Address - Phone:561-741-5566
Practice Address - Fax:561-295-5237
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY39237207R00000X
FLME 104656208M00000X
FLME104656207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000500922OtherANTHEM BCBS
FL004060900Medicaid
KY000000609095OtherANTHEM BCBS
OH2703542Medicaid
KY64111164Medicaid
OH2703542Medicaid
KY64111164Medicaid
FL004060900Medicaid