Provider Demographics
NPI:1700883444
Name:LINVILLE, W KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:KENNETH
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:PO BOX 3758
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3758
Mailing Address - Country:US
Mailing Address - Phone:361-980-0077
Mailing Address - Fax:
Practice Address - Street 1:7101 S PADRE ISLAND DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4913
Practice Address - Country:US
Practice Address - Phone:361-980-0079
Practice Address - Fax:361-985-3421
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8299207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101459902Medicaid
TX101459902Medicaid
TX80P997Medicare PIN