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General NPI Number Information
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NPI Number | 1124020912
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Entity Type | Individual
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Provider Name | LAWRENCE MAX LINETT MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2005
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 2307 N COLLEGE RD
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City | WILMINGTON
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State | NC
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Zip | 28405-6427
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Country | US
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Telephone | 910-392-1488
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Fax | 910-392-1489
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Provider Business Mailing Address
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Address Line | 1102 MARKET ST
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City | WILMINGTON
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State | NC
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Zip | 28401-4328
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Country | US
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Telephone | 910-763-4440
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Fax | 910-763-4445
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 29322
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 29322
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License Number State | NC
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