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General NPI Number Information
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NPI Number | 1235197161
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Entity Type | Individual
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Provider Name | LINDA ALIC MD
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Gender | Female
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 06/26/2022
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Provider Practice Location Address
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Address Line | 350 DOVER LN
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City | ROANOKE
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State | TX
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Zip | 76262-1149
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Country | US
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Telephone | 815-353-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MISSION ST STE 800
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City | SAN FRANCISCO
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State | CA
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Zip | 94105-1744
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Country | US
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Telephone | 415-231-5333
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Fax | 415-231-5332
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036066189
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License Number State | IL
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