Provider Demographics
NPI:1639271703
Name:MORROW, LYNN DICKERSON (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:DICKERSON
Last Name:MORROW
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 1:3300 S BROADWAY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7849
Mailing Address - Country:US
Mailing Address - Phone:903-533-8599
Mailing Address - Fax:903-533-8598
Practice Address - Street 1:3300 S BROADWAY AVE STE 101
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7849
Practice Address - Country:US
Practice Address - Phone:903-533-8599
Practice Address - Fax:903-533-8598
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH31252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC88506Medicare UPIN
TXD31LMedicare ID - Type Unspecified