Provider Demographics
NPI:1104013606
Name:LYNN, GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:LYNN
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 1:15899 LOS GATOS ALMADEN RD STE 9
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3739
Mailing Address - Country:US
Mailing Address - Phone:408-358-7460
Mailing Address - Fax:408-358-7463
Practice Address - Street 1:15899 LOS GATOS ALMADEN RD STE 9
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3739
Practice Address - Country:US
Practice Address - Phone:408-358-7460
Practice Address - Fax:408-358-7463
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60126174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A601260OtherMEDICARE
CA00A601260OtherMEDICARE