Provider Demographics
NPI:1831165232
Name:SELBY, LINDA CRASKA (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:CRASKA
Last Name:SELBY
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:PO BOX 7287
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-7287
Mailing Address - Country:US
Mailing Address - Phone:541-447-6263
Mailing Address - Fax:541-447-4698
Practice Address - Street 1:559 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BURNS
Practice Address - State:OR
Practice Address - Zip Code:97720-1441
Practice Address - Country:US
Practice Address - Phone:541-573-2074
Practice Address - Fax:541-573-8893
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD23626207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286773Medicaid
OR117099Medicare ID - Type UnspecifiedNORIDIAN MEDICARE
ORG37956Medicare UPIN