Provider Demographics
NPI:1467667626
Name:JOSE I DURAN MD PC
Entity type:Organization
Organization Name:JOSE I DURAN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:I
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-761-1603
Mailing Address - Street 1:494 N CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2453
Mailing Address - Country:US
Mailing Address - Phone:520-761-1603
Mailing Address - Fax:520-287-4471
Practice Address - Street 1:494 N. CARONDELET DR.
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2453
Practice Address - Country:US
Practice Address - Phone:520-761-1603
Practice Address - Fax:520-287-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14385AZ261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ61101OtherHUMANA
AZAZ0183670OtherBCBS
AZ245648Medicaid
AZ4045627OtherAETNA PPO
AZ91151OtherSTERLING
AZ627124OtherAETNA HMO
AZ1Z1662OtherHEALTHNET
AZ3323971004OtherCIGNA
AZAZ0183670OtherASBAIT
Z67249OtherMEDICARE
AZ1Z1662OtherHEALTHNET
AZ91151OtherSTERLING
AZAZ0183670OtherBCBS