Provider Demographics
NPI:1134417595
Name:LYNN, CECIL JAY (RDCS)
Entity type:Individual
Prefix:
First Name:CECIL
Middle Name:JAY
Last Name:LYNN
Suffix:
Gender:M
Credentials:RDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1403 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2031
Mailing Address - Country:US
Mailing Address - Phone:850-265-2071
Mailing Address - Fax:
Practice Address - Street 1:511 E 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5307
Practice Address - Country:US
Practice Address - Phone:850-747-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144556246XS1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography