Provider Demographics
NPI:1073685814
Name:FORY, LINDA WASHINGTON (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:WASHINGTON
Last Name:FORY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:KAREN
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8028
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:425 W CENTRAL AVE STE 201
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-2807
Practice Address - Country:US
Practice Address - Phone:372-080-5737
Practice Address - Fax:805-737-1772
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60481573208000000X
CAA73101208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A731010Medicaid
H56576Medicare UPIN
00A731010Medicare ID - Type Unspecified