Provider Demographics
NPI:1114587490
Name:LYNCH, CHRISTIE ANN (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIE
Middle Name:ANN
Last Name:LYNCH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 MATTIS RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2250
Mailing Address - Country:US
Mailing Address - Phone:314-909-1920
Mailing Address - Fax:314-909-1980
Practice Address - Street 1:3824 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1237
Practice Address - Country:US
Practice Address - Phone:314-352-5436
Practice Address - Fax:314-352-0749
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL561390200000X
MO2021035408213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program