Provider Demographics
NPI:1184726184
Name:DURKIN, WALTER JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JAMES
Last Name:DURKIN
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 1:60 DEEP WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1846
Mailing Address - Country:US
Mailing Address - Phone:386-451-0333
Mailing Address - Fax:
Practice Address - Street 1:60 DEEP WOODS WAY
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1846
Practice Address - Country:US
Practice Address - Phone:386-451-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33797207R00000X, 207RH0003X
OK28821207R00000X, 207RH0003X
FLME33797207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037826700Medicaid
FL64405EMedicare PIN
FLD65439Medicare UPIN