Provider Demographics
NPI:1225223399
Name:LYNCH, ARTHUR WILLIAM III (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WILLIAM
Last Name:LYNCH
Suffix:III
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:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-1408
Mailing Address - Country:US
Mailing Address - Phone:575-776-0869
Mailing Address - Fax:
Practice Address - Street 1:98 STATE HIGHWAY 150
Practice Address - Street 2:SUITE 7
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-0000
Practice Address - Country:US
Practice Address - Phone:575-776-1117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM15235874Medicaid
NMHSZ189OtherMEDICARE PART B
NMK3543Medicaid
NMH69304Medicare UPIN
NM15235874Medicaid