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General NPI Number Information
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NPI Number | 1982696589
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Entity Type | Organization
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Legal Business Name | TRACEY R BURTON LINDNER MD PA DBA
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 1001 COLLEGE BLVD W SUITE C
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City | NICEVILLE
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State | FL
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Zip | 32578-1099
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Country | US
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Telephone | 850-678-9009
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Fax | 850-678-3444
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Provider Business Mailing Address
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Address Line | 1001 COLLEGE BLVD W SUITE C
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City | NICEVILLE
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State | FL
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Zip | 32578-1099
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Country | US
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Telephone | 850-678-9009
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Fax | 850-678-3444
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. TRACEY R BURTON-LINDNER
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Credential | MD
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Telephone | 850-678-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0060775
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License Number State | FL
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