=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720178981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DOUGLAS SCOTT LINDNER PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 10/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 CAPEHART RD
-----------------------------------------------------
City | OFFUTT AFB
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-294-7413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 CAPEHART RD
-----------------------------------------------------
City | OFFUTT AFB
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68113-1043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 1229
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------