Provider Demographics
NPI:1780146894
Name:SOUTHGATE, LINDSAY MICHELLE
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MICHELLE
Last Name:SOUTHGATE
Suffix:
Gender:F
Credentials:
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 2270
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-2270
Mailing Address - Country:US
Mailing Address - Phone:970-384-7033
Mailing Address - Fax:970-945-5460
Practice Address - Street 1:1906 BLAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4259
Practice Address - Country:US
Practice Address - Phone:970-945-6535
Practice Address - Fax:970-945-5460
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0069401207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine