Provider Demographics
NPI:1902906787
Name:DERBES, LAWRENCE JR (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:DERBES
Suffix:JR
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-265-7070
Mailing Address - Fax:208-265-7071
Practice Address - Street 1:423 N THIRD AVE STE 355
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1511
Practice Address - Country:US
Practice Address - Phone:208-265-7070
Practice Address - Fax:208-265-7071
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-15859207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI578833-01Medicaid
HI536740OtherHMN
HI279541OtherUHA
HI0000242511OtherHMSA
HI536740OtherHMN
HI101414Medicare ID - Type Unspecified
HI578833-01Medicaid