Provider Demographics
NPI:1417121245
Name:LINCOLN, JOHN ANIL (MD PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANIL
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST STE 1014
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5301
Mailing Address - Country:US
Mailing Address - Phone:832-325-7080
Mailing Address - Fax:713-512-2239
Practice Address - Street 1:6410 FANNIN ST STE 1014
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-325-7080
Practice Address - Fax:713-512-2239
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN98942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX285918303Medicaid
TX8CX467OtherBCBS
TX8L29103OtherMEDICARE
TX285918304OtherCSHCN