Provider Demographics
NPI:1326360033
Name:TADD L SELBY MD ADULT & PEDIATRIC UROLOGY INC
Entity Type:Organization
Organization Name:TADD L SELBY MD ADULT & PEDIATRIC UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TADD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-893-0771
Mailing Address - Street 1:1166 ESPLANADE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3360
Mailing Address - Country:US
Mailing Address - Phone:530-893-0771
Mailing Address - Fax:530-893-1939
Practice Address - Street 1:1166 ESPLANADE
Practice Address - Street 2:SUITE 3
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3360
Practice Address - Country:US
Practice Address - Phone:530-898-1201
Practice Address - Fax:530-893-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADQ8534OtherMEDICARE RAILROAD PTAN
CAPENDINGMedicaid
CAPENDINGMedicaid