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NPI Code Detail

MEDICARE: MRS. LYNN DEE DERBY M.D.

MEDICARE: MRS. LYNN DEE DERBY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery PhysicianMD00033468WA
22082S0099XPlastic Surgery Within the Head and Neck (Plastic Surgery) PhysicianMD00033468WA
32082S0105XSurgery of the Hand (Plastic Surgery) PhysicianMD00033468WA
42086S0122XPlastic and Reconstructive Surgery PhysicianMD00033468WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2108611OTHERWAL&I PROVIDER #
3DE0378OTHERWAREGENCE/ASURIS PROVIDER #
47545OTHERWAGROUP HEALTH PROVIDER #
5000010003163OTHERWAREGENCE/BS PROVIDER #
6K7037OTHERIDBC-IDAHO MANAGED CARE GR#

General Provider Information

NPI Number : 1750385209
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNN DEE DERBY M.D.
Provider Business Mailing Address
First Line : 235 E ROWAN AVE
Second Line : STE 206
City : SPOKANE
State : WA
Zip : 99207-1240
Country : US
Telephone Number : 509-484-1212
Fax Number : 509-484-1277
Provider Business Practice Location Address
First Line : 235 E ROWAN AVE
Second Line : STE 206
City : SPOKANE
State : WA
Zip : 99207-1240
Country : US
Telephone Number : 509-484-1212
Fax Number : 509-484-1277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2005
Last Update Date : 03/18/2010

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Directions to “ MRS. LYNN DEE DERBY M.D.” Practice Location

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