Healthcare Provider Details

I. General information

NPI: 1538357165
Provider Name (Legal Business Name): LARRY LINNELL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 MEMORIAL DR
ARTESIA NM
88210-1189
US

IV. Provider business mailing address

PO BOX 54136
LUBBOCK TX
79453-4136
US

V. Phone/Fax

Practice location:
  • Phone: 505-746-9012
  • Fax: 505-746-9320
Mailing address:
  • Phone: 806-771-1386
  • Fax: 806-771-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number99248
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number99248
License Number StateNM

VIII. Authorized Official

Name: DR. LARRY LINNELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 806-771-1386