Individual
MICHAEL BRIAN LYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
100 E IDAHO ST STE 316, BOISE, ID 83712-6269
(208) 381-9350
(208) 381-9351
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MA054496
PA
363A00000X
Physician Assistant
Primary
7361377
ID
363A00000X
Physician Assistant
MA054496
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
251879554
TAX ID
PA
Enumeration date
11/30/2010
Last updated
12/18/2024
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