1962402461 NPI number — DR. STEVEN ALAN DUROCHER M.D.

Table of content: DR. STEVEN ALAN DUROCHER M.D. (NPI 1962402461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962402461 NPI number — DR. STEVEN ALAN DUROCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUROCHER
Provider First Name:
STEVEN
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1962402461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CORPORATE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508-3870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-893-9698
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1906 RAILROAD STREET, STE C
Provider Second Line Business Practice Location Address:
STATHAM FAMILY PRACTICE, PC
Provider Business Practice Location Address City Name:
STATHAM
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-753-1122
Provider Business Practice Location Address Fax Number:
678-753-0909
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  056051 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 056051 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 810703163I , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 810703163A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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