Provider Demographics
NPI:1033108691
Name:KILLION, LINZA TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:LINZA
Middle Name:TAYLOR
Last Name:KILLION
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 1:1106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5046
Mailing Address - Country:US
Mailing Address - Phone:573-471-8656
Mailing Address - Fax:573-471-8491
Practice Address - Street 1:1106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5046
Practice Address - Country:US
Practice Address - Phone:573-471-8656
Practice Address - Fax:573-471-8491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR9F16208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
141710OtherHEALTHLINK
24077OtherBLUE CROSS
141710OtherHEALTHLINK