Healthcare Provider Details

I. General information

NPI: 1679763759
Provider Name (Legal Business Name): LAWRENCE M LINETT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 S 17TH ST
WILMINGTON NC
28401-7748
US

IV. Provider business mailing address

2595 S 17TH ST
WILMINGTON NC
28401-7748
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-2788
  • Fax: 910-791-2711
Mailing address:
  • Phone: 910-791-2788
  • Fax: 910-791-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number29322
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. LAWRENCE MAX LINETT
Title or Position: OWNER
Credential: M.D.
Phone: 910-791-2788