Provider Demographics
NPI:1063634293
Name:DURHAM, TODD ALVIN (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALVIN
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-0229
Mailing Address - Country:US
Mailing Address - Phone:256-381-0400
Mailing Address - Fax:256-386-0065
Practice Address - Street 1:205 MARENGO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6033
Practice Address - Country:US
Practice Address - Phone:256-381-0400
Practice Address - Fax:256-386-0065
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO10672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I302143Medicare PIN