Provider Demographics
NPI:1750385209
Name:DERBY, LYNN DEE (MD)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:DEE
Last Name:DERBY
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 1:235 E ROWAN AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1240
Mailing Address - Country:US
Mailing Address - Phone:509-484-1212
Mailing Address - Fax:509-484-1277
Practice Address - Street 1:235 E ROWAN AVE
Practice Address - Street 2:STE 206
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1240
Practice Address - Country:US
Practice Address - Phone:509-484-1212
Practice Address - Fax:509-484-1277
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033468208200000X, 2082S0099X, 2082S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1098144Medicaid
WA108611OtherL&I PROVIDER #
WADE0378OtherREGENCE/ASURIS PROVIDER #
WA7545OtherGROUP HEALTH PROVIDER #
WA000010003163OtherREGENCE/BS PROVIDER #
IDK7037OtherBC-IDAHO MANAGED CARE GR#
240007970Medicare PIN
WA108611OtherL&I PROVIDER #
WA1098144Medicaid