Healthcare Provider Details

I. General information

NPI: 1528096195
Provider Name (Legal Business Name): WILLIAM JOSEPH DURIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5219 SAINT JOHN DR
ORR MN
55771-8232
US

IV. Provider business mailing address

5219 SAINT JOHN DR
ORR MN
55771-8232
US

V. Phone/Fax

Practice location:
  • Phone: 218-757-3650
  • Fax: 218-757-0234
Mailing address:
  • Phone: 218-757-3650
  • Fax: 218-757-0234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39025
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: