Healthcare Provider Details

I. General information

NPI: 1851303721
Provider Name (Legal Business Name): WILLIAM P DURANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 EAST 1000 SOUTH
FORT DUCHESNE UT
84026-1907
US

IV. Provider business mailing address

6822 EAST 1000 SOUTH
FORT DUCHESNE UT
84026
US

V. Phone/Fax

Practice location:
  • Phone: 435-725-6874
  • Fax:
Mailing address:
  • Phone: 435-725-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number170315-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: