Provider Demographics
NPI:1114904406
Name:LINVILLE, GEORGE P (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:LINVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:954 AVE C
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118
Mailing Address - Country:US
Mailing Address - Phone:619-545-1148
Mailing Address - Fax:619-767-7417
Practice Address - Street 1:COMNAVAIRFOR
Practice Address - Street 2:BOX 357051 NAS NI
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135-7051
Practice Address - Country:US
Practice Address - Phone:619-545-1148
Practice Address - Fax:619-767-7417
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014718208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery