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NPI Code Detail

MEDICARE: SHANE DURKIN MD

MEDICARE: SHANE DURKIN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician54251AZ
2207L00000XAnesthesiology Physician54251AZ

General Provider Information

NPI Number : 1912361395
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE DURKIN MD
Provider Business Mailing Address
First Line : 4605 E ELWOOD ST STE 500
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-1978
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4605 E ELWOOD ST STE 500
Second Line :
City : PHOENIX
State : AZ
Zip : 85040-1978
Country : US
Telephone Number : 480-577-2236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2016
Last Update Date : 06/03/2021

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Directions to “ SHANE DURKIN MD” Practice Location

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