Healthcare Provider Details

I. General information

NPI: 1467416891
Provider Name (Legal Business Name): LINTON BURNSIDE WEST M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HIDDEN HILLS DR
GREENVILLE SC
29605-3267
US

IV. Provider business mailing address

209 HIDDEN HILLS DR
GREENVILLE SC
29605-3267
US

V. Phone/Fax

Practice location:
  • Phone: 864-277-3681
  • Fax:
Mailing address:
  • Phone: 864-277-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number5897
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number5897
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: