Provider Demographics
NPI:1790717858
Name:DURANT, JOHN RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RAYMOND
Last Name:DURANT
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-0129
Mailing Address - Country:US
Mailing Address - Phone:256-825-7871
Mailing Address - Fax:256-825-5742
Practice Address - Street 1:301 MARIARDEN RD
Practice Address - Street 2:STE D
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-0129
Practice Address - Country:US
Practice Address - Phone:256-825-7871
Practice Address - Fax:256-825-5742
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19640208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL543420001Medicaid
AL051511570Medicare ID - Type Unspecified
AL543420001Medicaid