Provider Demographics
NPI:1811134265
Name:LYNN, JEFFERY R
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:R
Last Name:LYNN
Suffix:
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 1:8907 ENDICOTT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77096-2711
Mailing Address - Country:US
Mailing Address - Phone:281-333-4252
Mailing Address - Fax:281-333-4269
Practice Address - Street 1:8907 ENDICOTT LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77096-2711
Practice Address - Country:US
Practice Address - Phone:281-333-4252
Practice Address - Fax:281-333-4269
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX084500146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate