Provider Demographics
NPI:1992127732
Name:YIRA VAN DER LINDE MD LLC
Entity type:Organization
Organization Name:YIRA VAN DER LINDE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER LINDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-384-4033
Mailing Address - Street 1:PO BOX 17506
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7506
Mailing Address - Country:US
Mailing Address - Phone:850-437-9997
Mailing Address - Fax:850-439-2122
Practice Address - Street 1:1221 E DE SOTO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-3337
Practice Address - Country:US
Practice Address - Phone:850-437-9997
Practice Address - Fax:850-439-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME942422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH882Medicare UPIN