Provider Demographics
NPI:1467494435
Name:LIN, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:LIN
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:PO BOX 2464
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-2464
Mailing Address - Country:US
Mailing Address - Phone:480-507-9600
Mailing Address - Fax:
Practice Address - Street 1:3303 S LINDSAY RD
Practice Address - Street 2:STE 121
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-1503
Practice Address - Country:US
Practice Address - Phone:480-507-9600
Practice Address - Fax:480-507-9610
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31442208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ778582Medicaid
AZ111432Medicare PIN
AZH81520Medicare UPIN