Provider Demographics
NPI:1205842903
Name:LYNCH, PATRICK DEAN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:DEAN
Last Name:LYNCH
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 1:520 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1447
Mailing Address - Country:US
Mailing Address - Phone:928-684-5421
Mailing Address - Fax:928-684-2434
Practice Address - Street 1:520 ROSE LN
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1447
Practice Address - Country:US
Practice Address - Phone:928-684-5421
Practice Address - Fax:928-684-2434
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-114208207Q00000X
AZ44325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-114208OtherSTATE LICENSE
IL036-114208OtherSTATE LICENSE
K23607Medicare ID - Type UnspecifiedGROUP 211948
H98675Medicare UPIN
K23606Medicare ID - Type UnspecifiedGROUP 208476