Provider Demographics
NPI:1487935003
Name:WEN I LIN M.D., P.A.
Entity type:Organization
Organization Name:WEN I LIN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PA
Authorized Official - Phone:904-797-2921
Mailing Address - Street 1:3100 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6351
Mailing Address - Country:US
Mailing Address - Phone:904-797-2921
Mailing Address - Fax:904-797-6715
Practice Address - Street 1:3100 US HIGHWAY 1 S
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6351
Practice Address - Country:US
Practice Address - Phone:904-797-2921
Practice Address - Fax:904-797-6715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0032460174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55103OtherBLUECROSS
FL038135700Medicaid
FL5819011OtherAETNA
FL406343598OtherRAILROAD MEDICARE
FL038135700Medicaid
55103Medicare UPIN