Provider Demographics
NPI:1427026145
Name:DURAZO, ANTONIO JR (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:DURAZO
Suffix:JR
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 1:17452 ROAD 232
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-9555
Mailing Address - Country:US
Mailing Address - Phone:559-781-8080
Mailing Address - Fax:559-781-8960
Practice Address - Street 1:841 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3184
Practice Address - Country:US
Practice Address - Phone:559-781-8080
Practice Address - Fax:559-781-8960
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48642207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G486421Medicaid
CAZZZ31838ZMedicare ID - Type UnspecifiedMEDICARE
CA00G486421Medicaid