MEDICARE: DR. JAMES HARRIS DURRETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L3287	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8G5206	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1568409670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES HARRIS DURRETT M.D.

Provider Business Mailing Address
First Line	:	904 S BECKHAM AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-1906
Country	:	US
Telephone Number	:	903-360-6846
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 HIGHWAY 69 NORTH
Second Line	:
City	:	BULLARD
State	:	TX
Zip	:	75757
Country	:	US
Telephone Number	:	903-594-2450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/20/2007

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