Provider Demographics
NPI:1346250859
Name:CASE, LINDA MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:CASE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 63252
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80962-3252
Mailing Address - Country:US
Mailing Address - Phone:719-333-5183
Mailing Address - Fax:719-333-6351
Practice Address - Street 1:2355 FACULTY DRIVE
Practice Address - Street 2:SUITE 1N207 CADET FLIGHT MEDICINE CLINIC - 10TH AMDS
Practice Address - City:USAFA
Practice Address - State:CO
Practice Address - Zip Code:80840
Practice Address - Country:US
Practice Address - Phone:719-333-5183
Practice Address - Fax:719-333-6351
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28902204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF44092Medicare UPIN