Provider Demographics
NPI:1649299587
Name:LIN, BO (MD)
Entity type:Individual
Prefix:
First Name:BO
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 1:4301 GREATHOUSE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-8701
Mailing Address - Country:US
Mailing Address - Phone:479-684-3132
Mailing Address - Fax:479-684-3098
Practice Address - Street 1:4301 GREATHOUSE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-8701
Practice Address - Country:US
Practice Address - Phone:479-684-3132
Practice Address - Fax:479-684-3098
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-23392080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1401200001Medicaid
5L302Medicare ID - Type Unspecified
H02492Medicare UPIN