Healthcare Provider Details

I. General information

NPI: 1235286287
Provider Name (Legal Business Name): MICHAEL P DURR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 KENNEDY MEMORIAL DR SUITE 304
WATERVILLE ME
04901-4540
US

IV. Provider business mailing address

222 KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4526
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-7874
  • Fax: 207-861-4646
Mailing address:
  • Phone: 800-395-0232
  • Fax: 207-873-2385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number16655
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: