Healthcare Provider Details

I. General information

NPI: 1396036547
Provider Name (Legal Business Name): ASHLEY DURAY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 1ST ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

IV. Provider business mailing address

280 1ST ST BLDG 23
HOLLOMAN AFB NM
88330-8273
US

V. Phone/Fax

Practice location:
  • Phone: 575-572-4077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME118999
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: