Provider Demographics
NPI:1780616300
Name:LYNN, TODD HARRIS (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:HARRIS
Last Name:LYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7618 COACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2303
Mailing Address - Country:US
Mailing Address - Phone:713-729-6297
Mailing Address - Fax:
Practice Address - Street 1:7618 COACHWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2303
Practice Address - Country:US
Practice Address - Phone:713-729-6297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8115174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F0240Medicare ID - Type Unspecified
TXI30278Medicare UPIN