Healthcare Provider Details

I. General information

NPI: 1598750424
Provider Name (Legal Business Name): JEFFREY D. DURGIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST STE B
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 757-697-5775
  • Fax: 575-742-7856
Mailing address:
  • Phone: 575-769-7577
  • Fax: 575-742-7856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberL4353
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberL4353
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL4353
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD2025-0432
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberL4353
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: