MEDICARE: LYNDON SOE DO

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	OS7709	FL
2	207Q00000X	Family Medicine Physician	OS07709	FL

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

General Provider Information

NPI Number	:	1245204270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDON SOE DO

Provider Business Mailing Address
First Line	:	4901 34TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-4511
Country	:	US
Telephone Number	:	727-866-9945
Fax Number	:	727-866-9870

Provider Business Practice Location Address
First Line	:	4901 34TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33711-4511
Country	:	US
Telephone Number	:	727-866-9945
Fax Number	:	727-866-9870

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/02/2021

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Directions to “ LYNDON SOE DO” Practice Location

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