Provider Demographics
NPI:1588681407
Name:PERRY Y LIN MD PC
Entity Type:Organization
Organization Name:PERRY Y LIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-213-6303
Mailing Address - Street 1:77 W FOREST AVE
Mailing Address - Street 2:203
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1483
Mailing Address - Country:US
Mailing Address - Phone:928-213-6303
Mailing Address - Fax:928-213-6304
Practice Address - Street 1:77 W FOREST AVE
Practice Address - Street 2:203
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1483
Practice Address - Country:US
Practice Address - Phone:928-213-6303
Practice Address - Fax:928-213-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27274207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ462531Medicaid
G17977Medicare UPIN
AZ462531Medicaid