Provider Demographics
NPI:1932109238
Name:LINDE, RONALD LARRY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LARRY
Last Name:LINDE
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 1:500 WATER ST S
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2060
Mailing Address - Country:US
Mailing Address - Phone:507-645-6619
Mailing Address - Fax:
Practice Address - Street 1:500 WATER ST S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2060
Practice Address - Country:US
Practice Address - Phone:507-645-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN021884207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN517783900Medicaid
MN517783900Medicaid
D75546Medicare UPIN