Provider Demographics
NPI:1013932540
Name:DURST, JOHN WAKEFIELD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WAKEFIELD
Last Name:DURST
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 1:50 WATERTREE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2686
Mailing Address - Country:US
Mailing Address - Phone:281-367-6262
Mailing Address - Fax:
Practice Address - Street 1:1001 MEDICAL PLAZA DR STE 280
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3209
Practice Address - Country:US
Practice Address - Phone:281-363-4450
Practice Address - Fax:281-292-3462
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15019207VX0000X
TXF1520207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3113553Medicaid
TXF1520OtherSTATE MD LICENSE