Provider Demographics
NPI:1811161771
Name:LINAM, MARK SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:SCOTT
Last Name:LINAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1204
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90651-1204
Mailing Address - Country:US
Mailing Address - Phone:562-868-0787
Mailing Address - Fax:562-375-6188
Practice Address - Street 1:12820 STUDEBAKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2578
Practice Address - Country:US
Practice Address - Phone:562-868-0787
Practice Address - Fax:562-375-6188
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35000Medicaid
CAE3500Medicare PIN
CAT19344Medicare UPIN
CA6324100001Medicare NSC