Provider Demographics
NPI:1629203120
Name:DURBIN, IRINA G (PA-C)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:G
Last Name:DURBIN
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1150 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-3758
Mailing Address - Country:US
Mailing Address - Phone:417-336-4112
Mailing Address - Fax:417-335-4684
Practice Address - Street 1:1150 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-3758
Practice Address - Country:US
Practice Address - Phone:417-336-4112
Practice Address - Fax:417-335-4684
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-07-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1549007Medicare PIN