Provider Demographics
NPI:1841293198
Name:LYNCH, ROBERT DALE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DALE
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18550 US HIGHWAY 441
Mailing Address - Street 2:STE A
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-6751
Mailing Address - Country:US
Mailing Address - Phone:407-889-4281
Mailing Address - Fax:
Practice Address - Street 1:18540 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-6725
Practice Address - Country:US
Practice Address - Phone:352-383-7743
Practice Address - Fax:352-383-9226
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2016-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME55532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL080184834OtherRR MEDICARE
FLG19132Medicare UPIN
FL080184834OtherRR MEDICARE