Provider Demographics
NPI:1598727075
Name:LINDOR, PAMELA ALIX (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ALIX
Last Name:LINDOR
Suffix:
Gender:F
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:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-633-0460
Mailing Address - Fax:904-633-0461
Practice Address - Street 1:6271 SAINT AUGUSTINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2523
Practice Address - Country:US
Practice Address - Phone:904-633-0460
Practice Address - Fax:904-633-0461
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79718208000000X
FLME115116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA631155027BMedicaid
FL008106700Medicaid
MA3126315Medicaid
FL14P8ZOtherBCBS
GA27-0547617OtherTAX ID
GA27-0547617OtherTAX ID
MA3126315Medicaid