Provider Demographics
NPI:1083497242
Name:LINDE, ALAN JOSEPH
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JOSEPH
Last Name:LINDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W KEETOOWAH ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-3820
Mailing Address - Country:US
Mailing Address - Phone:918-708-9474
Mailing Address - Fax:
Practice Address - Street 1:118 W KEETOOWAH ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-3820
Practice Address - Country:US
Practice Address - Phone:918-708-9474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist