Provider Demographics
NPI:1417102666
Name:MCREYNOLDS, LAWRENCE LYNCH (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:LYNCH
Last Name:MCREYNOLDS
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 1:7137 COUNTY ROAD 5
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9734
Mailing Address - Country:US
Mailing Address - Phone:925-254-4213
Mailing Address - Fax:
Practice Address - Street 1:7137 COUNTY ROAD 5
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-9734
Practice Address - Country:US
Practice Address - Phone:925-254-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC363312084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BM0940898OtherDEA
BM0940898OtherDEA
A36231Medicare UPIN