Provider Demographics
NPI:1699700377
Name:SELBY, TADD LEIGH (MD)
Entity type:Individual
Prefix:DR
First Name:TADD
Middle Name:LEIGH
Last Name:SELBY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 ESPLANADE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3361
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:95926-3327
Practice Address - Country:US
Practice Address - Phone:530-893-0771
Practice Address - Fax:530-893-1939
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79258208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G792580Medicaid
CA00G792580Medicaid
CADG805ZMedicare PIN
CA00G792580Medicare ID - Type Unspecified