Provider Demographics
NPI:1346535143
Name:LINCOLN, JEWEL C (DO)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:C
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-2507
Mailing Address - Country:US
Mailing Address - Phone:361-552-6721
Mailing Address - Fax:361-552-2863
Practice Address - Street 1:1200 N VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-2507
Practice Address - Country:US
Practice Address - Phone:361-552-6721
Practice Address - Fax:361-552-2863
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10038566207Q00000X
TXP0756207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine