Provider Demographics
NPI:1588682785
Name:LYNN, WILLIAM STEVE (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEVE
Last Name:LYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-2915
Mailing Address - Country:US
Mailing Address - Phone:870-364-5746
Mailing Address - Fax:870-364-5745
Practice Address - Street 1:103 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-2915
Practice Address - Country:US
Practice Address - Phone:870-364-5746
Practice Address - Fax:870-364-5745
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARH25157Medicare UPIN
AR5L626Medicare ID - Type Unspecified