Provider Demographics
NPI:1194710087
Name:LIN, SHWU-FANG (MD)
Entity type:Individual
Prefix:
First Name:SHWU-FANG
Middle Name:
Last Name:LIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0373
Mailing Address - Country:US
Mailing Address - Phone:409-772-2538
Mailing Address - Fax:409-772-5293
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0373
Practice Address - Country:US
Practice Address - Phone:409-772-0425
Practice Address - Fax:409-772-5293
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38699208000000X
TX426122080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3894880Medicare ID - Type Unspecified
I07412Medicare UPIN