Provider Demographics
NPI:1821367525
Name:DURHAM, STEPHANIE PHINNEY (MD, ND)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:PHINNEY
Last Name:DURHAM
Suffix:
Gender:F
Credentials:MD, ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7689 SW CAPITOL HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2475
Mailing Address - Country:US
Mailing Address - Phone:503-445-4454
Mailing Address - Fax:
Practice Address - Street 1:7689 SW CAPITOL HWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2475
Practice Address - Country:US
Practice Address - Phone:503-445-4454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1848175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath