Healthcare Provider Details

I. General information

NPI: 1619571429
Provider Name (Legal Business Name): ROBERT R DURHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566H TEALTOWN RD
BATAVIA OH
45103-1025
US

IV. Provider business mailing address

PO BOX 416
BATAVIA OH
45103-0416
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-7496
  • Fax: 513-943-7480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: