Provider Demographics
NPI:1841218526
Name:DURR, CINDY L (DO)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:DURR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEMORIAL DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6751
Mailing Address - Country:US
Mailing Address - Phone:618-474-1711
Mailing Address - Fax:618-474-2793
Practice Address - Street 1:4 MEMORIAL DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6751
Practice Address - Country:US
Practice Address - Phone:618-474-1711
Practice Address - Fax:618-474-2793
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8505208000000X
OK4067208000000X
IL036149773208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200015510BMedicaid