Healthcare Provider Details

I. General information

NPI: 1780736132
Provider Name (Legal Business Name): LINDA A LEAR M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

IV. Provider business mailing address

101 ORCHARD DR
NICHOLASVILLE KY
40356-2690
US

V. Phone/Fax

Practice location:
  • Phone: 859-881-4288
  • Fax: 859-881-4388
Mailing address:
  • Phone: 859-881-4288
  • Fax: 859-881-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29434
License Number StateKY

VIII. Authorized Official

Name: MR. KEVIN LEAR
Title or Position: ADMINISTRATOR
Credential:
Phone: 859-881-4288