Provider Demographics
NPI:1932366416
Name:HEATHER M LINN MD PA
Entity Type:Organization
Organization Name:HEATHER M LINN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MAUDE
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-614-5636
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:SUGARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-0024
Mailing Address - Country:US
Mailing Address - Phone:281-614-5636
Mailing Address - Fax:
Practice Address - Street 1:2401 FM 646 RD W
Practice Address - Street 2:SUITE C
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3249
Practice Address - Country:US
Practice Address - Phone:281-614-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH58212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010NVOtherBCBS
TX188946101Medicaid
TX188946101Medicaid