Basic Information
Provider Information
NPI: 1114972254
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIN
FirstName: PAUL
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5700 LAKE WORTH RD
Address2: #204
City: LAKE WORTH
State: FL
PostalCode: 33463
CountryCode: US
TelephoneNumber: 5619687968
FaxNumber: 5619644603
Practice Location
Address1: 5401 S CONGRESS AVE
Address2: STE 105
City: ATLANTIS
State: FL
PostalCode: 334626635
CountryCode: US
TelephoneNumber: 5614394682
FaxNumber: 5619680483
Other Information
ProviderEnumerationDate: 05/24/2006
LastUpdateDate: 01/21/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XME95685FLY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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