MEDICARE: MYRON RAE LINDLEY ST. LOUIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	ME 107124	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2086S0129X	Vascular Surgery Physician	MD438171	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164636783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRON RAE LINDLEY ST. LOUIS MD

Provider Business Mailing Address
First Line	:	4301 SUN N LAKE BLVD
Second Line	:	SUITE 103
City	:	SEBRING
State	:	FL
Zip	:	33872-2162
Country	:	US
Telephone Number	:	863-385-1900
Fax Number	:	863-385-9229

Provider Business Practice Location Address
First Line	:	4301 SUN N LAKE BLVD
Second Line	:	SUITE 103
City	:	SEBRING
State	:	FL
Zip	:	33872-2162
Country	:	US
Telephone Number	:	863-385-1900
Fax Number	:	863-385-9229

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/23/2013

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