Provider Demographics
NPI:1245213396
Name:WALBY, LINDA LEE (MD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LEE
Last Name:WALBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W 27TH PL STE B302
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2904
Mailing Address - Country:US
Mailing Address - Phone:509-591-4427
Mailing Address - Fax:509-820-3160
Practice Address - Street 1:4309 W 27TH PL STE B302
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-2904
Practice Address - Country:US
Practice Address - Phone:509-591-4427
Practice Address - Fax:509-820-3160
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10678A208100000X
WAMD60405789208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI015822245Medicare ID - Type Unspecified
WIWI01R1OtherJOHN DEERE
WIP00069877OtherRAILROAD MEDICARE
WI390807236BTOtherUNITY
WI13595OtherDEAN
WI004716130Medicare ID - Type Unspecified