Provider Demographics
NPI:1275756066
Name:DURHAM, PAMELA (LAC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 BROWN TRL
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6499
Mailing Address - Country:US
Mailing Address - Phone:817-285-0622
Mailing Address - Fax:817-285-7076
Practice Address - Street 1:1424 BROWN TRL
Practice Address - Street 2:SUITE B
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6499
Practice Address - Country:US
Practice Address - Phone:817-285-0622
Practice Address - Fax:817-285-7076
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00776171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist