Provider Demographics
NPI:1447295019
Name:LYNAM, EDWARD PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:PATRICK
Last Name:LYNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 COOKTOWN ROAD
Mailing Address - Street 2:#8
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1749
Mailing Address - Country:US
Mailing Address - Phone:775-354-8271
Mailing Address - Fax:
Practice Address - Street 1:1508 COOKTOWN RD
Practice Address - Street 2:#8
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-2199
Practice Address - Country:US
Practice Address - Phone:775-354-8271
Practice Address - Fax:775-354-8271
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-044679-L2084P0804X
LA3019952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509087Medicaid
NVF76561Medicare UPIN
NVV102214Medicare ID - Type Unspecified