Provider Demographics
NPI:1639166622
Name:DURHAM, WILLIAM TRACY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TRACY
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 1:10 MCDOWELL ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4104
Mailing Address - Country:US
Mailing Address - Phone:828-258-8545
Mailing Address - Fax:828-254-0714
Practice Address - Street 1:10 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4104
Practice Address - Country:US
Practice Address - Phone:828-258-8545
Practice Address - Fax:828-254-0714
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500034207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901383Medicaid
NC2037952Medicare PIN
NCI31323Medicare UPIN
NCP00297820Medicare PIN