Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME111877 | FL |
NPI | 1033184304 |
---|---|
Provider Name | Mr. Dean Richard Lindstrom III |
First Address | Melbourne, FL 32901-3117 |
Second Address | Melbourne, FL 32901-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 15/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004547400 | (05) | FL |
I04755 | (02) |