Provider Demographics
NPI:1194990515
Name:DULTZ, LINDA A (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:A
Last Name:DULTZ
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9158
Mailing Address - Country:US
Mailing Address - Phone:214-648-3917
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD STE 514
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0005
Practice Address - Country:US
Practice Address - Phone:214-648-3917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79584208600000X
TXR3664208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110464100Medicaid
MD110464100Medicaid
MD518664YVEMedicare PIN