Provider Demographics
NPI:1497701692
Name:THOMAS, LYNN C (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:C
Last Name:THOMAS
Suffix:
Gender:F
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 7357
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72217-7357
Mailing Address - Country:US
Mailing Address - Phone:501-771-4121
Mailing Address - Fax:501-771-1363
Practice Address - Street 1:1601 MURPHY DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6187
Practice Address - Country:US
Practice Address - Phone:501-771-4121
Practice Address - Fax:501-771-1363
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-10392084P0800X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134673001Medicaid
ARG67427Medicare UPIN
AR134673001Medicaid