Provider Demographics
NPI:1992794317
Name:HORTON, LYNN (MD)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LINDSAY LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4103
Mailing Address - Country:US
Mailing Address - Phone:307-578-1800
Mailing Address - Fax:307-578-1814
Practice Address - Street 1:921 S BALLANCEE
Practice Address - Street 2:
Practice Address - City:LUSK
Practice Address - State:WY
Practice Address - Zip Code:82225-0780
Practice Address - Country:US
Practice Address - Phone:307-334-4000
Practice Address - Fax:307-334-0183
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6138A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY312893OtherBLUE CROSS BLUE SHIELD
WYP00162968OtherRAILROAD MEDICARE
MT0078846Medicaid
WY121109900Medicaid
WYP00162968OtherRAILROAD MEDICARE
WYE49261Medicare UPIN