Provider Demographics
NPI:1376529826
Name:LYN, IAN T (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:T
Last Name:LYN
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 1:1600 MEDICAL CENTER ST STE 212
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5008
Mailing Address - Country:US
Mailing Address - Phone:915-532-3977
Mailing Address - Fax:915-532-5866
Practice Address - Street 1:1600 MEDICAL CENTER ST STE 212
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5008
Practice Address - Country:US
Practice Address - Phone:915-532-3977
Practice Address - Fax:915-532-5866
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30645208G00000X
TXJ8651208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177598302Medicaid
TX177598302Medicaid
TXI46071Medicare UPIN