1467667626 NPI number — JOSE I DURAN MD PC

Table of content: (NPI 1467667626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467667626 NPI number — JOSE I DURAN MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSE I DURAN MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467667626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
494 N CARONDELET DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOGALES
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85621-2453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-761-1603
Provider Business Mailing Address Fax Number:
520-287-4471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
494 N. CARONDELET DR.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOGALES
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85621-2453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-761-1603
Provider Business Practice Location Address Fax Number:
520-287-4471
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURAN
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
I
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-761-1603

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  14385AZ , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61101 . This is a "HUMANA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0183670 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 245648 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4045627 . This is a "AETNA PPO" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 91151 . This is a "STERLING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 627124 . This is a "AETNA HMO" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z1662 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3323971004 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0183670 . This is a "ASBAIT" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z67249 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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