Healthcare Provider Details

I. General information

NPI: 1295938652
Provider Name (Legal Business Name): LINDA RUTH DERBES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4919 S MIAMI BLVD
DURHAM NC
27703-8435
US

IV. Provider business mailing address

4919 S MIAMI BLVD
DURHAM NC
27703-8435
US

V. Phone/Fax

Practice location:
  • Phone: 919-302-7812
  • Fax:
Mailing address:
  • Phone: 919-302-7812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberG81106
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number95-0012
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number12523
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberG81106
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: