1750385209 NPI number — MRS. LYNN DEE DERBY M.D.

Table of content: (NPI 1730785114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750385209 NPI number — MRS. LYNN DEE DERBY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERBY
Provider First Name:
LYNN
Provider Middle Name:
DEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750385209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
235 E ROWAN AVE
Provider Second Line Business Mailing Address:
STE 206
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99207-1240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-484-1212
Provider Business Mailing Address Fax Number:
509-484-1277

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
235 E ROWAN AVE
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-484-1212
Provider Business Practice Location Address Fax Number:
509-484-1277
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  MD00033468 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2082S0099X , with the licence number: MD00033468 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: MD00033468 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: MD00033468 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1098144 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108611 . This is a "L&I PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DE0378 . This is a "REGENCE/ASURIS PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7545 . This is a "GROUP HEALTH PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000010003163 . This is a "REGENCE/BS PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: K7037 . This is a "BC-IDAHO MANAGED CARE GR#" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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