Provider Demographics
NPI:1023011723
Name:ROYALL, LINDA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:JEAN
Last Name:ROYALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:JEAN ROYALL
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1367 DOMINION PLZ
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1013
Mailing Address - Country:US
Mailing Address - Phone:903-564-6200
Mailing Address - Fax:903-939-0755
Practice Address - Street 1:19222 STONEHUE
Practice Address - Street 2:STE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3454
Practice Address - Country:US
Practice Address - Phone:210-497-1475
Practice Address - Fax:210-497-1502
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4925174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FB111OtherBCBS PV#
TXC14589Medicare UPIN
TX8F8669Medicare PIN