Healthcare Provider Details

I. General information

NPI: 1154437184
Provider Name (Legal Business Name): LINDA LOUISE ALEXANDER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 120
JACKSONVILLE BEACH FL
32250-3260
US

IV. Provider business mailing address

2376 FOXHAVEN DR W
JACKSONVILLE FL
32224-2010
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-2655
  • Fax: 904-249-2425
Mailing address:
  • Phone: 904-221-3224
  • Fax: 904-220-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 0002222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: