Provider Demographics
NPI:1043620560
Name:LINDSEY, BRENDEN (RADIOLOGYADMINISTRAT)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:
Last Name:LINDSEY
Suffix:
Gender:M
Credentials:RADIOLOGYADMINISTRAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3787 CARDINAL OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-4250
Mailing Address - Country:US
Mailing Address - Phone:904-303-3338
Mailing Address - Fax:
Practice Address - Street 1:42 DOCTORS VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHN'S
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-230-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57571247100000X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist