Healthcare Provider Details

I. General information

NPI: 1295836864
Provider Name (Legal Business Name): CATHERINE L LINDERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 E SUNNYSIDE RD
IDAHO FALLS ID
83404-8280
US

IV. Provider business mailing address

2375 E SUNNYSIDE RD
IDAHO FALLS ID
83404-8280
US

V. Phone/Fax

Practice location:
  • Phone: 208-524-0610
  • Fax: 208-557-0171
Mailing address:
  • Phone: 208-524-0610
  • Fax: 208-557-0171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberM-6069
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: