Provider Demographics
NPI:1295311298
Name:LYNCH, JERRY II
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:LYNCH
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-4024
Mailing Address - Country:US
Mailing Address - Phone:225-329-7041
Mailing Address - Fax:
Practice Address - Street 1:3206 BALDWIN DR
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-4024
Practice Address - Country:US
Practice Address - Phone:225-329-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver