Provider Demographics
NPI:1790865434
Name:EWING, LINETTE JEANNA (DO)
Entity Type:Individual
Prefix:DR
First Name:LINETTE
Middle Name:JEANNA
Last Name:EWING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LINETTE
Other - Middle Name:JEANNA
Other - Last Name:TIBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MPH
Mailing Address - Street 1:P O BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1129208D00000X
VA0102202051208D00000X
TXS0284208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8LK675OtherBCBS
TX400636302OtherMEDICAID CSHCN
TX400636301Medicaid