Healthcare Provider Details

I. General information

NPI: 1750572103
Provider Name (Legal Business Name): JEAN MAURICE DURE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 NE 55TH BLVD
GAINESVILLE FL
32641-2783
US

IV. Provider business mailing address

9816 SW 150TH RUN
LAKE BUTLER FL
32054-7120
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-7732
  • Fax: 904-964-3829
Mailing address:
  • Phone:
  • Fax: 904-964-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16163
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: