Healthcare Provider Details

I. General information

NPI: 1598727075
Provider Name (Legal Business Name): PAMELA ALIX LINDOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 SAINT AUGUSTINE RD
JACKSONVILLE FL
32217-2523
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0460
  • Fax: 904-633-0461
Mailing address:
  • Phone: 904-633-0460
  • Fax: 904-633-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79718
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115116
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: