Basic Information
| Provider Information | |||||||||
| NPI: | 1760441430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CANAVAN | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | DIDONATO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 ALLIANCE BLVD STE 750 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750935354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725625999 | ||||||||
| FaxNumber: | 9725629755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | J2864 | TX | N | Allopathic & Osteopathic Physicians | Surgery | 2086X0206X | J2864 | TX | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 127583606 | 05 | TX | MEDICAID | 8W4998 | 01 | TX | BCBSTX | OTHER | P00620587 | 01 | TX | MEDICARE RAILROAD | OTHER |