Provider Demographics
NPI:1043296122
Name:LINKLATER, DEREK R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:R
Last Name:LINKLATER
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 1:2205 RAVENHILL CIR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1307
Mailing Address - Country:US
Mailing Address - Phone:254-493-4472
Mailing Address - Fax:
Practice Address - Street 1:36065 SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5060
Practice Address - Country:US
Practice Address - Phone:254-493-4472
Practice Address - Fax:512-710-1314
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7799207P00000X, 2080P0204X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164777801Medicaid
TX164764604Medicaid
TX8C0840OtherBCBS
TX8C0840OtherBCBS
TX164777801Medicaid
TXI04167Medicare UPIN