Provider Demographics
NPI:1952481913
Name:LIN, WALTER (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:LIN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11500 OLIVE BLVD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7143
Mailing Address - Country:US
Mailing Address - Phone:314-925-0903
Mailing Address - Fax:
Practice Address - Street 1:11500 OLIVE BLVD
Practice Address - Street 2:SUITE 235
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7143
Practice Address - Country:US
Practice Address - Phone:314-925-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89450207R00000X
MO2014018787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine