Provider Demographics
NPI:1932196698
Name:LIN-DYKEN, DEBORAH C (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:C
Last Name:LIN-DYKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:C
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-353-6132
Mailing Address - Fax:319-356-8284
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-353-6132
Practice Address - Fax:319-356-8284
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA266052080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0273573Medicaid
IA27357OtherWELLMARK BCBS
IA27357OtherWELLMARK BCBS
IA27357Medicare PIN
IA0273573Medicaid