Provider Demographics
NPI:1962771196
Name:LYNN, JOHN T (III, MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LYNN
Suffix:
Gender:M
Credentials:III, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 TECH CENTER DR
Mailing Address - Street 2:120
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2339
Mailing Address - Country:US
Mailing Address - Phone:719-265-1100
Mailing Address - Fax:719-265-1101
Practice Address - Street 1:5450 TECH CENTER DR
Practice Address - Street 2:120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-2339
Practice Address - Country:US
Practice Address - Phone:719-265-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24958207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31034870Medicaid
CO31034870OtherNPI# FOR EVERCARE HOSPICE AND PALLIATIVE CARE 1609911827
CO31034870OtherNPI# FOR EVERCARE HOSPICE AND PALLIATIVE CARE 1609911827