Healthcare Provider Details

I. General information

NPI: 1700078896
Provider Name (Legal Business Name): TIMOTHY JAMES DURKIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TIMOTHY J. DURKIN DO

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST STE 101
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

PO BOX 160
SHIPROCK NM
87420-0160
US

V. Phone/Fax

Practice location:
  • Phone: 505-208-6280
  • Fax: 505-564-3202
Mailing address:
  • Phone: 505-368-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS14541
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberCDRH.0055714
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberA-1501-09
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: