Healthcare Provider Details

I. General information

NPI: 1881717767
Provider Name (Legal Business Name): DAVID JONATHAN DURHAM C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 E RACE AVE
SEARCY AR
72143-4727
US

IV. Provider business mailing address

2221 E RACE AVE
SEARCY AR
72143-4727
US

V. Phone/Fax

Practice location:
  • Phone: 501-368-0868
  • Fax: 501-368-0003
Mailing address:
  • Phone: 501-368-0868
  • Fax: 501-368-0003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: