Provider Demographics
NPI:1639657091
Name:REYMUNDE DURAN, DIEGO ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:ANDRE
Last Name:REYMUNDE DURAN
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 1:3400 MONTROSE BLVD APT 1006
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4330
Mailing Address - Country:US
Mailing Address - Phone:787-365-9161
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN STREET SUITE MSB 1.134
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5389
Practice Address - Country:US
Practice Address - Phone:713-500-6500
Practice Address - Fax:713-500-6497
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU5215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program