Provider Demographics
NPI:1023079928
Name:DURBIN, PATRICK H (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:H
Last Name:DURBIN
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 1:6901 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109
Mailing Address - Country:US
Mailing Address - Phone:314-644-7000
Mailing Address - Fax:314-644-7101
Practice Address - Street 1:6901 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109
Practice Address - Country:US
Practice Address - Phone:314-644-7000
Practice Address - Fax:314-644-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5F18207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202982955Medicaid