Provider Demographics
NPI:1114044542
Name:LYNCH, CHRISTOPHER ROBERT (CST,CSFA, RN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ROBERT
Last Name:LYNCH
Suffix:
Gender:M
Credentials:CST,CSFA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 101292
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76185-1292
Mailing Address - Country:US
Mailing Address - Phone:817-852-6927
Mailing Address - Fax:817-531-2939
Practice Address - Street 1:4216 SW LOOP 820
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-5350
Practice Address - Country:US
Practice Address - Phone:817-852-6927
Practice Address - Fax:817-531-2939
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808232163W00000X
151900246ZC0007X
100964246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
100964OtherCST,CFA
TX808232OtherRN
151900OtherCST/CSFA