MEDICARE: DOUGLAS FLETCHER LINDAHL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OP00001739	WA

General Provider Information

NPI Number	:	1043215916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS FLETCHER LINDAHL D.O.

Provider Business Mailing Address
First Line	:	901 MOUNTAIN VIEW DR
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-4401
Country	:	US
Telephone Number	:	360-426-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 MOUNTAIN VIEW DR
Second Line	:
City	:	SHELTON
State	:	WA
Zip	:	98584-4401
Country	:	US
Telephone Number	:	360-426-1611
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/03/2017

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