Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD00033468 | WA |
Y | 208600000X | Surgeon | MD00033468 | WA |
N | 2082S0105X | Plastic Hand Surgeon | MD00033468 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00033468 | WA |
NPI | 1750385209 |
---|---|
Provider Name | Mrs. Lynn Dee Derby |
First Address | Spokane, WA 99207-1240 |
Second Address | Spokane, WA 99207-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 18/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010003163 | REGENCE/BS PROVIDER # (01) | WA |
108611 | L&I PROVIDER # (01) | WA |
1098144 | (05) | WA |
7545 | GROUP HEALTH PROVIDER # (01) | WA |
DE0378 | REGENCE/ASURIS PROVIDER # (01) | WA |
G26122 | (02) | |
K7037 | BC-IDAHO MANAGED CARE GR# (01) | ID |