Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | L0380 | TX |
NPI | 1124082938 |
---|---|
Provider Name | Dr. Jeffrey C Lin |
First Address | Fort Worth, TX 76104-3903 |
Second Address | Fort Worth, TX 76104-3903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 01/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046466101 | (05) | TX |
046466102 | MEDICAID - WCCA (01) | TX |
8HT657 | BCBSTX - WCCA (01) | TX |
H22201 | (02) | TX |