Provider Demographics
NPI:1447244603
Name:LIN, REY C (MD)
Entity Type:Individual
Prefix:
First Name:REY
Middle Name:C
Last Name:LIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REY
Other - Middle Name:C
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 E POLK ST
Mailing Address - Street 2:POB 909
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-1237
Mailing Address - Country:US
Mailing Address - Phone:319-653-6601
Mailing Address - Fax:319-653-5624
Practice Address - Street 1:400 E POLK ST
Practice Address - Street 2:POB 909
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-1237
Practice Address - Country:US
Practice Address - Phone:319-653-6601
Practice Address - Fax:319-653-5624
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6038380Medicaid
IA6038380Medicaid
IA01339Medicare PIN