Provider Demographics
NPI:1093772089
Name:DURAN, JOSE I (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:I
Last Name:DURAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 N GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-1061
Mailing Address - Country:US
Mailing Address - Phone:520-281-1550
Mailing Address - Fax:520-281-1112
Practice Address - Street 1:1209 W TARGET RANGE RD
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2466
Practice Address - Country:US
Practice Address - Phone:520-287-4747
Practice Address - Fax:520-281-1112
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14385AZ174400000X
AZ14385207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ245648Medicaid
AZ4045627OtherAETNA PPO
AZ0183670OtherASBAIT AEI
AZAZ0183670OtherBCBS
AZ1Z1662OtherHEALTHNET
AZ860587287002OtherTRICARE
AZ3323971004OtherCIGNA
AZ627124OtherAETNA HMO
AZAZ0183670OtherBCBS
AZZ67249Medicare ID - Type Unspecified