Provider Demographics
NPI:1689645178
Name:LINAN, ENRIQUE WILDER (MD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:WILDER
Last Name:LINAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0014
Mailing Address - Country:US
Mailing Address - Phone:956-581-6606
Mailing Address - Fax:956-581-6775
Practice Address - Street 1:1317 SAINT CLAIRE BLVD
Practice Address - Street 2:SUITE # A-4
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-581-6606
Practice Address - Fax:956-581-6775
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL54342081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156145801Medicaid
TX8H8630OtherBCBS
TX156146601Medicaid
H20013Medicare UPIN
TX156145801Medicaid