1164426912 NPI number — HOWARD LINZER D.O.

Table of content: HOWARD LINZER D.O. (NPI 1164426912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164426912 NPI number — HOWARD LINZER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LINZER
Provider First Name:
HOWARD
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164426912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8223 E THOMAS RD
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85207-9601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-744-9040
Provider Business Mailing Address Fax Number:
480-380-5053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6400 DAVIS BLVD
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34104-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-775-2300
Provider Business Practice Location Address Fax Number:
239-775-4312
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  OS0007727 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 258604500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 015044200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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