Provider Demographics
NPI:1639201361
Name:COLON, LINDA (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:COLON
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 1:4382 FOXTAIL LANE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-927-3767
Mailing Address - Fax:954-389-7493
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-752-8446
Practice Address - Fax:954-752-8464
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBC2426167208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265630200Medicaid