Healthcare Provider Details

I. General information

NPI: 1790983807
Provider Name (Legal Business Name): BRIAN JOSEPH LINDENMAYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 S SAINT ELIZABETH BLVD
GONZALES LA
70737-5021
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-8511
  • Fax: 225-644-5213
Mailing address:
  • Phone: 225-526-0011
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number203963
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: