Provider Demographics
NPI:1558384271
Name:LE, LYNN T (MD)
Entity Type:Individual
Prefix:MISS
First Name:LYNN
Middle Name:T
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GIALINH
Other - Middle Name:THI
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 W GORE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-848-6811
Mailing Address - Fax:407-930-8249
Practice Address - Street 1:70 W GORE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1124
Practice Address - Country:US
Practice Address - Phone:407-848-6811
Practice Address - Fax:407-930-8249
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL43129OtherBCBS
P00210942OtherRAILROAD MEDICARE
FL269783100Medicaid
FL43129ZMedicare PIN
P00210942OtherRAILROAD MEDICARE