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Individual

TRISTAN K LINEBERRY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
215 E MAIN ST, PROVIDENCE, KY 42450-1261
(270) 667-7017
Mailing address
PO BOX 37, PROVIDENCE, KY 42450-0037
(270) 667-7017
(270) 667-9065

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21614
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000044292
BCBS PROVIDER NUMBER
01
21614
LICENSE
KY
05
64216146
KY
Enumeration date
09/16/2006
Last updated
03/02/2018
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