Provider Demographics
NPI:1912011701
Name:LINDER, OWEN (MD)
Entity Type:Individual
Prefix:DR
First Name:OWEN
Middle Name:
Last Name:LINDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3454
Mailing Address - Country:US
Mailing Address - Phone:727-726-4721
Mailing Address - Fax:727-797-6316
Practice Address - Street 1:960 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3454
Practice Address - Country:US
Practice Address - Phone:727-726-4721
Practice Address - Fax:727-797-6316
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME038208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0668028-00Medicaid
FL62360Medicare ID - Type Unspecified
FLC46086Medicare UPIN