Provider Demographics
NPI:1093008831
Name:SANDRA LYNN PRICE MD INC
Entity Type:Organization
Organization Name:SANDRA LYNN PRICE MD INC
Other - Org Name:SANDRA LYNN PRICE MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-5151
Mailing Address - Street 1:628 SE 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4429
Mailing Address - Country:US
Mailing Address - Phone:352-732-5151
Mailing Address - Fax:352-690-7800
Practice Address - Street 1:628 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4429
Practice Address - Country:US
Practice Address - Phone:352-732-5151
Practice Address - Fax:352-690-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0016373207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42091OtherMEDICARE PROVIDER TRANSACTION #
FLD54765Medicare UPIN