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General NPI Number Information
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NPI Number | 1326005190
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Entity Type | Individual
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Provider Name | MICHEAL J DURHAM D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 755 COWAN DR
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City | LEBANON
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State | MO
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Zip | 65536-4629
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Country | US
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Telephone | 417-532-2805
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Fax | 417-532-2848
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Provider Business Mailing Address
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Address Line | 54 HOSPITAL DR
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City | OSAGE BEACH
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State | MO
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Zip | 65065-3050
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Country | US
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Telephone | 573-348-8000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2010019729
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License Number State | MO
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