Provider Demographics
NPI:1457197808
Name:LYNCH, COLLIN (MSOM, DOM)
Entity type:Individual
Prefix:DR
First Name:COLLIN
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:MSOM, DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NORTE TRL
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9015
Mailing Address - Country:US
Mailing Address - Phone:305-496-9648
Mailing Address - Fax:
Practice Address - Street 1:22 NORTE TRL
Practice Address - Street 2:
Practice Address - City:PLACITAS
Practice Address - State:NM
Practice Address - Zip Code:87043-9015
Practice Address - Country:US
Practice Address - Phone:305-496-9648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMAOM-2024-00112083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine