Provider Demographics
NPI: | 1720018419 |
---|---|
Name: | DURST, DEBRA R (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DEBRA |
Middle Name: | R |
Last Name: | DURST |
Suffix: | |
Gender: | F |
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: | PO BOX 634706 |
Mailing Address - Street 2: | |
Mailing Address - City: | CINCINNATI |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45263-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1924 ALCOA HWY |
Practice Address - Street 2: | |
Practice Address - City: | KNOXVILLE |
Practice Address - State: | TN |
Practice Address - Zip Code: | 37920-1511 |
Practice Address - Country: | US |
Practice Address - Phone: | 865-544-9000 |
Practice Address - Fax: | 865-539-8008 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-05 |
Last Update Date: | 2007-11-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 37682 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | 4067380 | Other | BLUE CROSS |
TN | 3888581 | Medicaid | |
KY | 64078298 | Medicaid | |
TN | 3888584 | Medicaid | |
TN | 4067382 | Other | BLUE CROSS |
TN | P00231016 | Other | RAILROAD MEDICARE |
TN | 4067380 | Other | BLUE CROSS |
TN | G75887 | Medicare UPIN | |
KY | 64078298 | Medicaid |