MEDICARE: JEFFREY SAMUEL LINDABERRY 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	207Q00000X	Family Medicine Physician	712	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	712	OTHER	SC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1164414546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY SAMUEL LINDABERRY D.O.

Provider Business Mailing Address
First Line	:	108 FINNEGAN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-903-9993
Fax Number	:	843-903-3356

Provider Business Practice Location Address
First Line	:	108 FINNEGAN CT
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579
Country	:	US
Telephone Number	:	843-903-9993
Fax Number	:	843-903-3356

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/22/2021

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