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General NPI Number Information
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NPI Number | 1023011723
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Entity Type | Individual
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Provider Name | LINDA JEAN ROYALL M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 19222 STONEHUE STE 103
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City | SAN ANTONIO
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State | TX
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Zip | 78258-3454
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Country | US
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Telephone | 210-497-1475
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Fax | 210-497-1502
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Provider Business Mailing Address
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Address Line | 1367 DOMINION PLZ
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City | TYLER
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State | TX
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Zip | 75703-1013
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Country | US
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Telephone | 903-564-6200
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Fax | 903-939-0755
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G4925
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G4925
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License Number State | TX
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