Provider Demographics
NPI:1962630749
Name:LYNCH, JERRY DOUGLAS (PA)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:DOUGLAS
Last Name:LYNCH
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6340 S PADRE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4038
Mailing Address - Country:US
Mailing Address - Phone:361-854-4626
Mailing Address - Fax:
Practice Address - Street 1:3845 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-2919
Practice Address - Country:US
Practice Address - Phone:361-854-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00276363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant