Provider Demographics
NPI:1790960904
Name:BEAUPIN, LYNDA M (MD)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:M
Last Name:BEAUPIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:
Other - Last Name:KWON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 5TH ST S STE 302
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-4176
Mailing Address - Fax:727-767-4379
Practice Address - Street 1:601 5TH ST S STE 302
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-767-4176
Practice Address - Fax:727-767-4379
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1357582080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024445300Medicaid