Provider Demographics
NPI:1558366765
Name:DURHAM, STEPHEN BRYAN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BRYAN
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 1:4402 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6161
Mailing Address - Country:US
Mailing Address - Phone:910-452-1400
Mailing Address - Fax:910-332-1072
Practice Address - Street 1:4402 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6161
Practice Address - Country:US
Practice Address - Phone:910-452-1400
Practice Address - Fax:910-332-1072
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800520207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911378Medicaid
SCQ0052BMedicaid
NC01-28754OtherUNITED HEALTHCARE
NC930077029OtherRAILROAD MEDICARE
NCB4544OtherMEDCOST
NC11378OtherBCBS
NC930084670OtherRAILROAD MEDICARE
NC01-28754OtherUNITED HEALTHCARE
SCQ0052BMedicaid
NC2254478CMedicare PIN
NC2254478DMedicare PIN