Provider Demographics
NPI:1508012709
Name:FOUTZ, LINDSAY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:D
Last Name:FOUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:R
Other - Last Name:DENICOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0333
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:3 SHIRCLIFF WAY STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4785
Practice Address - Country:US
Practice Address - Phone:904-384-3699
Practice Address - Fax:904-384-8529
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106954207V00000X
IL125-051810207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002190500Medicaid
FL002190500Medicaid