Healthcare Provider Details

I. General information

NPI: 1013194208
Provider Name (Legal Business Name): JOSHUA DURHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 12/21/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8921 W HACKAMORE DR
BOISE ID
83709-1673
US

IV. Provider business mailing address

8921 W HACKAMORE DR
BOISE ID
83709-1673
US

V. Phone/Fax

Practice location:
  • Phone: 208-994-4123
  • Fax:
Mailing address:
  • Phone: 208-994-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberO-0684
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: