Healthcare Provider Details

I. General information

NPI: 1508002320
Provider Name (Legal Business Name): RICHARD MANUEL DURAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HI LINE DR APT 2015
DALLAS TX
75207-3451
US

IV. Provider business mailing address

1400 HI LINE DR APT 2015
DALLAS TX
75207-3451
US

V. Phone/Fax

Practice location:
  • Phone: 214-484-9099
  • Fax:
Mailing address:
  • Phone: 305-495-4376
  • Fax: 972-759-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1886
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: