Provider Demographics
NPI:1013955491
Name:GIBNEY, LYNN ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:ARTHUR
Last Name:GIBNEY
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 1:5388 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEEDWAY
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6818
Mailing Address - Country:US
Mailing Address - Phone:317-241-2107
Mailing Address - Fax:317-240-1198
Practice Address - Street 1:5388 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SPEEDWAY
Practice Address - State:IN
Practice Address - Zip Code:46224-6818
Practice Address - Country:US
Practice Address - Phone:317-241-2107
Practice Address - Fax:317-240-1198
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000385A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100061860Medicaid
IN100061860Medicaid
INT34534Medicare UPIN