Healthcare Provider Details

I. General information

NPI: 1750491221
Provider Name (Legal Business Name): GARY A. LINNEMANN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 E WARNER AVE SUITE A
SANTA ANA CA
92705-5475
US

IV. Provider business mailing address

1534 E WARNER AVE SUITE A
SANTA ANA CA
92705-5475
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-5599
  • Fax: 714-557-5005
Mailing address:
  • Phone: 714-557-5599
  • Fax: 714-557-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA41712
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA41712
License Number StateCA

VIII. Authorized Official

Name: DR. GARY A. LINNEMANN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-557-5599