Provider Demographics
NPI:1235103268
Name:DURHAM, JOHN G (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3165 MCCRORY PL
Mailing Address - Street 2:STE 174
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3727
Mailing Address - Country:US
Mailing Address - Phone:407-423-1234
Mailing Address - Fax:407-517-1040
Practice Address - Street 1:499 E CENTRAL PARKWY
Practice Address - Street 2:STE 120
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-331-7844
Practice Address - Fax:407-478-3595
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO 2241213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390041000Medicaid
FLP00112206OtherR/R MEDICARE
FLT97552Medicare UPIN
FLP00112206OtherR/R MEDICARE