Provider Demographics
NPI:1033281373
Name:LINCOLN, ANNIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-2142
Mailing Address - Country:US
Mailing Address - Phone:806-795-9777
Mailing Address - Fax:806-795-0799
Practice Address - Street 1:2310 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-2142
Practice Address - Country:US
Practice Address - Phone:806-795-9777
Practice Address - Fax:806-795-0799
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG42382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00TY53OtherBLUE CROSS BLUE SHIELD
TX00TY53Medicare ID - Type Unspecified
TN00TY53OtherBLUE CROSS BLUE SHIELD