Provider Demographics
NPI:1245483478
Name:LYNCH, KATHY SUE (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:SUE
Last Name:LYNCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3104
Mailing Address - Country:US
Mailing Address - Phone:970-564-9777
Mailing Address - Fax:970-564-8833
Practice Address - Street 1:118 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3104
Practice Address - Country:US
Practice Address - Phone:970-564-9777
Practice Address - Fax:970-564-8833
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60140024207Q00000X
CO50521207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59983388Medicaid