Healthcare Provider Details

I. General information

NPI: 1992127732
Provider Name (Legal Business Name): YIRA VAN DER LINDE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 E DE SOTO ST
PENSACOLA FL
32501-3337
US

IV. Provider business mailing address

PO BOX 17506
PENSACOLA FL
32522-7506
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-9997
  • Fax: 850-439-2122
Mailing address:
  • Phone: 850-437-9997
  • Fax: 850-439-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME94242
License Number StateFL

VIII. Authorized Official

Name: YIRA VAN DER LINDE
Title or Position: OWNER
Credential: MD
Phone: 850-384-4033