Provider Demographics
NPI:1982696589
Name:TRACEY R BURTON LINDNER MD PA DBA
Entity Type:Organization
Organization Name:TRACEY R BURTON LINDNER MD PA DBA
Other - Org Name:PEDIATRICS OF OKALOOSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURTON-LINDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-678-9009
Mailing Address - Street 1:1001 COLLEGE BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1099
Mailing Address - Country:US
Mailing Address - Phone:850-678-9009
Mailing Address - Fax:850-678-3444
Practice Address - Street 1:1001 COLLEGE BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1099
Practice Address - Country:US
Practice Address - Phone:850-678-9009
Practice Address - Fax:850-678-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060775208000000X
FLME0056714208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty