Healthcare Provider Details

I. General information

NPI: 1689674418
Provider Name (Legal Business Name): CARLOS DURHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR UNIT 103C
THE WOODLANDS TX
77384-4000
US

IV. Provider business mailing address

PO BOX 200649
HOUSTON TX
77216-0649
US

V. Phone/Fax

Practice location:
  • Phone: 936-273-1133
  • Fax: 936-273-1335
Mailing address:
  • Phone: 281-580-9030
  • Fax: 281-580-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG5007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: