Provider Demographics
NPI:1740241926
Name:LYNCH, DONALD MATTHEW (DPM)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MATTHEW
Last Name:LYNCH
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:2601 THORNTON LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1808
Practice Address - Country:US
Practice Address - Phone:254-724-6622
Practice Address - Fax:254-742-6620
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX848213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87G895OtherBLUE SHIELD
TX480030634OtherRR/MEDICARE
TX1122103-02OtherCSHCN
TX87G895OtherBLUE SHIELD
TX1122103-03Medicaid
TXT14524Medicare UPIN