Provider Demographics
NPI:1649508847
Name:DREW DURBIN, DO, PLLC
Entity type:Organization
Organization Name:DREW DURBIN, DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DREW
Authorized Official - Middle Name:A
Authorized Official - Last Name:DURBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-779-4999
Mailing Address - Street 1:16601 N 40TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3355
Mailing Address - Country:US
Mailing Address - Phone:480-779-4999
Mailing Address - Fax:480-779-4998
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE #119-120
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3345
Practice Address - Country:US
Practice Address - Phone:480-779-4999
Practice Address - Fax:480-779-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-27
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ133998Medicare PIN