Individual
DR. LARRY WADE LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4055 VALLEY VIEW LN STE 700, DALLAS, TX 75244-5045
(855) 984-5121
Mailing address
4055 VALLEY VIEW LN STE 700, DALLAS, TX 75244-5045
(855) 984-5121
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01037887
IN
208D00000X
General Practice Physician
01037887A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100356530
—
IN
01
—
P01456893
MEDICARE RAILROAD PTAN
IN
Enumeration date
03/15/2007
Last updated
07/06/2023
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