Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | MD438171 | PA |
Y | 2086S0129X | Vascular Surgeon | ME 107124 | FL |
NPI | 1164636783 |
---|---|
Provider Name | Myron Rae Lindley St. Louis |
First Address | Sebring, FL 33872-2162 |
Second Address | Sebring, FL 33872-2162 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 23/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002469000 | (05) | FL |
DF170Z | (02) | FL |