Provider Demographics
NPI:1063560084
Name:HUSTON, LINDSAY M (MD)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:M
Last Name:HUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4301
Mailing Address - Country:US
Mailing Address - Phone:510-642-6621
Mailing Address - Fax:510-642-1801
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-8237
Practice Address - Country:US
Practice Address - Phone:510-642-6621
Practice Address - Fax:510-642-1801
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA94664207Q00000X
CTO46887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine