Provider Demographics
NPI:1295938652
Name:DERBES, LINDA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:RUTH
Last Name:DERBES
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 1:4919 S MIAMI BLVD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8435
Mailing Address - Country:US
Mailing Address - Phone:919-302-7812
Mailing Address - Fax:
Practice Address - Street 1:4919 S MIAMI BLVD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8435
Practice Address - Country:US
Practice Address - Phone:919-302-7812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81106283Q00000X, 103TP0016X
NC95-0012283Q00000X
HI12523283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No283Q00000XHospitalsPsychiatric Hospital