Provider Demographics
NPI:1558127910
Name:LINCOLN, WILEY DENNIS
Entity Type:Individual
Prefix:MR
First Name:WILEY
Middle Name:DENNIS
Last Name:LINCOLN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 N AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2729
Mailing Address - Country:US
Mailing Address - Phone:512-810-0070
Mailing Address - Fax:
Practice Address - Street 1:2809 EARL RUDDER FWY S STE 203
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7383
Practice Address - Country:US
Practice Address - Phone:210-413-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program