Healthcare Provider Details

I. General information

NPI: 1689898819
Provider Name (Legal Business Name): JOSHUA LEE DURHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 MADISON OAK DR STE 310
SAN ANTONIO TX
78258-4298
US

IV. Provider business mailing address

8711 VILLAGE DR STE 114
SAN ANTONIO TX
78217-5419
US

V. Phone/Fax

Practice location:
  • Phone: 210-483-0888
  • Fax: 210-494-1740
Mailing address:
  • Phone: 210-483-0888
  • Fax: 210-494-1740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR1947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: