Healthcare Provider Details

I. General information

NPI: 1609987791
Provider Name (Legal Business Name): TERESA V DURBIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 W ANTELOPE DR #290
LAYTON UT
84041
US

IV. Provider business mailing address

1580 W ANTELOPE DR #290
LAYTON UT
84041
US

V. Phone/Fax

Practice location:
  • Phone: 801-776-0880
  • Fax: 801-773-7399
Mailing address:
  • Phone: 801-776-0880
  • Fax: 801-773-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1878661205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: