Healthcare Provider Details

I. General information

NPI: 1013317460
Provider Name (Legal Business Name): SCOTT FORRESTER LINDSEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 10/08/2022
Certification Date: 10/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S. MACDILL AVE. SUITE 201
TAMPA FL
33609
US

IV. Provider business mailing address

4919 MEMORIAL HWY STE 150
TAMPA FL
33634-7516
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-3810
  • Fax: 813-559-1846
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME136463
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME136463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: