Provider Demographics
NPI:1811958077
Name:DILLIN, P. LINDEN (MD)
Entity type:Individual
Prefix:DR
First Name:P.
Middle Name:LINDEN
Last Name:DILLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LINDEN
Other - Middle Name:LINDEN
Other - Last Name:DILLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:900 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3919
Mailing Address - Country:US
Mailing Address - Phone:817-335-3668
Mailing Address - Fax:817-335-5304
Practice Address - Street 1:900 12TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3919
Practice Address - Country:US
Practice Address - Phone:817-335-3668
Practice Address - Fax:817-335-5304
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3906207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15271Medicare UPIN