Provider Demographics
NPI:1831117043
Name:LYNN, JEFFREY A (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
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 1:3255 E. LIVINGSTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1967
Mailing Address - Country:US
Mailing Address - Phone:614-239-9444
Mailing Address - Fax:614-239-1080
Practice Address - Street 1:3255 E. LIVINGSTON AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1967
Practice Address - Country:US
Practice Address - Phone:614-239-9444
Practice Address - Fax:614-239-1080
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-002657213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0909548Medicaid
OHPO1521836Medicare PIN
OH0909548Medicaid
OHH390882Medicare PIN
OHP01573296Medicare PIN
OH4208663Medicare PIN
OH0722557Medicare PIN
OH0722559Medicare PIN
OH4208661Medicare PIN