Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | G4238 | TX |
NPI | 1033281373 |
---|---|
Provider Name | Dr. Annie Lincoln |
First Address | Lubbock, TX 79410-2142 |
Second Address | Lubbock, TX 79410-2142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00TY53 | BLUE CROSS BLUE SHIELD (01) | TN |
B24400 | (02) | TX |