Provider Demographics
NPI:1558304766
Name:LYNN, MARTIN S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:S
Last Name:LYNN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 AVENUE D
Mailing Address - Street 2:#293
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1742
Mailing Address - Country:US
Mailing Address - Phone:206-355-3701
Mailing Address - Fax:206-577-2931
Practice Address - Street 1:1429 AVENUE D
Practice Address - Street 2:#293
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-1742
Practice Address - Country:US
Practice Address - Phone:206-355-3701
Practice Address - Fax:206-577-2931
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50387OtherLABOR AND INDUSTRY
WA1085711Medicaid
WA00104715Medicare ID - Type Unspecified
WA1085711Medicaid