Basic Information
| Provider Information | |||||||||
| NPI: | 1962771196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYNN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | III, M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 TECH CENTER DR | ||||||||
| Address2: | 120 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809192339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192651100 | ||||||||
| FaxNumber: | 7192651101 | ||||||||
| Practice Location | |||||||||
| Address1: | 5450 TECH CENTER DR | ||||||||
| Address2: | 120 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809192339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192651100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2011 | ||||||||
| LastUpdateDate: | 07/31/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0002X | 24958 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31034870 | 05 | CO | MEDICAID | 31034870 | 01 | CO | NPI# FOR EVERCARE HOSPICE AND PALLIATIVE CARE 1609911827 | OTHER |