Healthcare Provider Details

I. General information

NPI: 1326005190
Provider Name (Legal Business Name): MICHEAL J DURHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 COWAN DR
LEBANON MO
65536-4629
US

IV. Provider business mailing address

54 HOSPITAL DR
OSAGE BEACH MO
65065-3050
US

V. Phone/Fax

Practice location:
  • Phone: 417-532-2805
  • Fax: 417-532-2848
Mailing address:
  • Phone: 573-348-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4291
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2010019729
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: