Provider Demographics
NPI:1972517472
Name:LYNN, LORI A (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:LYNN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK EAST DR
Mailing Address - Street 2:SUITE 356
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3200
Mailing Address - Fax:205-838-6981
Practice Address - Street 1:48 MEDICAL PARK EAST DR
Practice Address - Street 2:SUITE 356
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3200
Practice Address - Fax:205-838-6981
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009972355Medicaid
AL1538173281OtherGROUP NPI
AL51528670OtherBCBS
ALCK7413OtherRR MEDICARE GROUP ID
AL051556109Medicaid
ALP00274219OtherNEW RR MEDICARE PTAN 5/9/08
ALJ210OtherGROUP MEDICARE
P00167784OtherRR MCR
AL51528670OtherBCBS
ALP00274219OtherNEW RR MEDICARE PTAN 5/9/08