Provider Demographics
NPI:1093893216
Name:DURHAM, WILLIAM R (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:DURHAM
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 1:513 18TH ST
Mailing Address - Street 2:PO BOX 459
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701
Mailing Address - Country:US
Mailing Address - Phone:606-526-9664
Mailing Address - Fax:606-526-6263
Practice Address - Street 1:513 18TH ST
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701
Practice Address - Country:US
Practice Address - Phone:606-526-9664
Practice Address - Fax:606-526-6263
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32642207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64326424Medicaid
G37714Medicare UPIN
KY64326424Medicaid