Provider Demographics
NPI:1497898282
Name:LYNN, LON DAVID (DO)
Entity Type:Individual
Prefix:MR
First Name:LON
Middle Name:DAVID
Last Name:LYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3910 NORTHDALE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1800
Mailing Address - Country:US
Mailing Address - Phone:813-264-7922
Mailing Address - Fax:813-264-6585
Practice Address - Street 1:3910 NORTHDALE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1800
Practice Address - Country:US
Practice Address - Phone:813-264-7922
Practice Address - Fax:813-264-6585
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82600Medicare ID - Type Unspecified
FLD14763Medicare UPIN