Provider Demographics
NPI:1518908425
Name:LINZAG, OMAR LIRIO (PT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:LIRIO
Last Name:LINZAG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-957-0385
Mailing Address - Fax:903-957-4006
Practice Address - Street 1:321 N HIGHLAND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7378
Practice Address - Country:US
Practice Address - Phone:903-957-0385
Practice Address - Fax:903-957-4006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073286174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86915TOtherBCBS
TX86915TOtherBCBS