Provider Demographics
NPI:1891297446
Name:DURR, JERRY L JR
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:DURR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 LAKE EFFIE LN W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-0988
Mailing Address - Country:US
Mailing Address - Phone:904-762-6591
Mailing Address - Fax:
Practice Address - Street 1:8229 LAKE EFFIE LN W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-0988
Practice Address - Country:US
Practice Address - Phone:904-762-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL600832413830343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)