Provider Demographics
NPI:1740201086
Name:LINN, BERNARD J (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:LINN
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 1:1601 N HARRISON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-2376
Mailing Address - Country:US
Mailing Address - Phone:605-945-1371
Mailing Address - Fax:605-945-3237
Practice Address - Street 1:1601 N HARRISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2383
Practice Address - Country:US
Practice Address - Phone:605-945-1371
Practice Address - Fax:605-945-3237
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6001592Medicaid
SD0006923OtherBCBS
SDS6923Medicare PIN
SD0006923OtherBCBS
D25432Medicare UPIN
SD0369350001Medicare NSC