MEDICARE: LAWRENCE M LINETT, MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	29322	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52071	OTHER	NC	BC/BS

General Provider Information

NPI Number	:	1396938171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE M LINETT, MD, PLLC

Provider Business Mailing Address
First Line	:	2595 S 17TH ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7748
Country	:	US
Telephone Number	:	910-791-2788
Fax Number	:	910-791-2711

Provider Business Practice Location Address
First Line	:	431 WESTERN BLVD STE E
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6823
Country	:	US
Telephone Number	:	910-355-6000
Fax Number	:	910-355-7533

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE M. LINETT
Credential	:	M.D.
Telephone Number	:	910-791-2788

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	10/07/2014

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