Provider Demographics
NPI:1346691904
Name:JD DURGIN MD BASIN SURGICAL PLLC
Entity Type:Organization
Organization Name:JD DURGIN MD BASIN SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DURHAM
Authorized Official - Last Name:DURGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-218-4870
Mailing Address - Street 1:3323 N MIDLAND DR
Mailing Address - Street 2:113 155
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-4608
Mailing Address - Country:US
Mailing Address - Phone:800-218-4870
Mailing Address - Fax:432-247-1632
Practice Address - Street 1:1811 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6531
Practice Address - Country:US
Practice Address - Phone:800-218-4870
Practice Address - Fax:432-247-1632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207P00000X, 208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty