Healthcare Provider Details

I. General information

NPI: 1093772089
Provider Name (Legal Business Name): JOSE I DURAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W TARGET RANGE RD
NOGALES AZ
85621-2466
US

IV. Provider business mailing address

825 N GRAND AVE STE 100
NOGALES AZ
85621-1061
US

V. Phone/Fax

Practice location:
  • Phone: 520-287-4747
  • Fax: 520-281-1112
Mailing address:
  • Phone: 520-281-1550
  • Fax: 520-281-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number14385AZ
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14385
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: