Provider Demographics
NPI:1396709622
Name:LINVILLE, MICHEAL RAY (DPM)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:RAY
Last Name:LINVILLE
Suffix:
Gender:M
Credentials:DPM
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 2583
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2583
Mailing Address - Country:US
Mailing Address - Phone:256-381-3878
Mailing Address - Fax:256-381-6040
Practice Address - Street 1:2200A 2ND ST
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-1271
Practice Address - Country:US
Practice Address - Phone:256-381-3878
Practice Address - Fax:256-381-6040
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0259213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
515-11248OtherBLUE CROSS
ALT-68885Medicare UPIN
515-11248OtherBLUE CROSS
AL5086070001Medicare NSC
ALT-68885Medicare UPIN