Provider Demographics
NPI:1821006040
Name:LIN, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
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 1:403 W CAMPBELL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3465
Mailing Address - Country:US
Mailing Address - Phone:972-235-8311
Mailing Address - Fax:972-235-2663
Practice Address - Street 1:403 W CAMPBELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3465
Practice Address - Country:US
Practice Address - Phone:972-235-8311
Practice Address - Fax:972-235-2663
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK5333OtherMEDICAL LICENSE
TXH25396Medicare UPIN
TXK5333OtherMEDICAL LICENSE