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General NPI Number Information
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NPI Number | 1265638100
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Entity Type | Organization
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Legal Business Name | DURHAM FAMILY MEDICINE INC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 03/31/2010
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Provider Practice Location Address
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Address Line | 203 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6818
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Country | US
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Telephone | 918-540-3500
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Fax | 918-540-3506
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Provider Business Mailing Address
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Address Line | 203 2ND AVE SW
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City | MIAMI
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State | OK
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Zip | 74354-6818
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Country | US
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Telephone | 918-540-3500
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Fax | 918-540-3506
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Authorized Official
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Title or Position | OWNER
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Name | MICHEAL JEFFERY DURHAM
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Credential | D.O.
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Telephone | 918-540-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4291
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License Number State | OK
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