Provider Demographics
NPI:1417949744
Name:LYNCH, HEATHER RENE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RENE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2701 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-5246
Mailing Address - Country:US
Mailing Address - Phone:405-789-4150
Mailing Address - Fax:405-491-0743
Practice Address - Street 1:2701 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-5246
Practice Address - Country:US
Practice Address - Phone:405-789-4150
Practice Address - Fax:405-491-0743
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK20559207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100096920AMedicaid
OK100096920AMedicaid