Healthcare Provider Details

I. General information

NPI: 1124551189
Provider Name (Legal Business Name): DURELL MEDICAL SERVICES, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 ROBERTS CUT OFF RD
RIVER OAKS TX
76114-2023
US

IV. Provider business mailing address

1711 ROBERTS CUT OFF RD
RIVER OAKS TX
76114-2023
US

V. Phone/Fax

Practice location:
  • Phone: 817-731-7004
  • Fax: 817-731-6999
Mailing address:
  • Phone: 817-731-7004
  • Fax: 817-731-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberP3183
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberP3183
License Number StateTX

VIII. Authorized Official

Name: DR. JASON ALBERT KOURI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 817-731-7004