Provider Demographics
NPI:1699260562
Name:LYNCH, IAN THOMAS
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:THOMAS
Last Name:LYNCH
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 1:4521 KENTSFIELD LN APT 205
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-3558
Mailing Address - Country:US
Mailing Address - Phone:812-746-2383
Mailing Address - Fax:
Practice Address - Street 1:4521 KENTSFIELD LN APT 205
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-3558
Practice Address - Country:US
Practice Address - Phone:812-746-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018020842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine