Provider Demographics
NPI:1164636783
Name:ST. LOUIS, MYRON RAE LINDLEY (MD)
Entity Type:Individual
Prefix:
First Name:MYRON
Middle Name:RAE LINDLEY
Last Name:ST. LOUIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2162
Mailing Address - Country:US
Mailing Address - Phone:863-385-1900
Mailing Address - Fax:863-385-9229
Practice Address - Street 1:4301 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2162
Practice Address - Country:US
Practice Address - Phone:863-385-1900
Practice Address - Fax:863-385-9229
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1071242086S0129X
390200000X
PAMD4381712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002469000Medicaid
FL002469000Medicaid