Basic Information
| Provider Information | |||||||||
| NPI: | 1003895301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LINDLEY | ||||||||
| FirstName: | ANCIL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6478 HIGHWAY 90 | ||||||||
| Address2: | STE D | ||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8505641030 | ||||||||
| FaxNumber: | 8505641039 | ||||||||
| Practice Location | |||||||||
| Address1: | 6002 BERRYHILL RD | ||||||||
| Address2: | |||||||||
| City: | MILTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8506269942 | ||||||||
| FaxNumber: | 8506265808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 04/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 19922 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 038039300 | 05 | FL | MEDICAID |