Provider Demographics
NPI:1699747915
Name:LYNCH, DURWARD (CNP)
Entity type:Individual
Prefix:
First Name:DURWARD
Middle Name:
Last Name:LYNCH
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2901
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547-2901
Mailing Address - Country:US
Mailing Address - Phone:928-468-8603
Mailing Address - Fax:928-468-8625
Practice Address - Street 1:806 S PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5541
Practice Address - Country:US
Practice Address - Phone:928-468-8603
Practice Address - Fax:928-468-8625
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR31638363L00000X
AZAP5348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPROVP14270OtherMOLINA
NM201006124OtherPRESBYTERIAN HEALTH/SALUD
AZ332817Medicaid
NM96361Medicaid
NM10002113OtherLOVELACE HEALTH/SALUD
500000924OtherRAILROAD MEDICARE
NMNM00BT16OtherBC/BS
NMNM00BT16OtherBC/BS