Provider Demographics
NPI:1821180134
Name:LINFORD, DOUGLAS SEAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:SEAN
Last Name:LINFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 W PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-7766
Mailing Address - Country:US
Mailing Address - Phone:208-772-8263
Mailing Address - Fax:208-772-0603
Practice Address - Street 1:566 W PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7766
Practice Address - Country:US
Practice Address - Phone:208-772-8263
Practice Address - Fax:208-772-0603
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT51391207205207Q00000X
IDM-9877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807815900Medicaid
ID0225241OtherLABOR & INDUSTRY
ID0225241OtherLABOR & INDUSTRY
ID807815900Medicaid