Healthcare Provider Details

I. General information

NPI: 1548273501
Provider Name (Legal Business Name): ELLEN W LIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WAN-TIN LIN

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 SPURS LANE SUITE 240
SAN ANTONIO TX
78240-1669
US

IV. Provider business mailing address

21 SPURS LANE SUITE 240
SAN ANTONIO TX
78240-1669
US

V. Phone/Fax

Practice location:
  • Phone: 210-690-0777
  • Fax: 210-690-0779
Mailing address:
  • Phone: 210-690-0777
  • Fax: 210-690-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberM0151
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: