Provider Demographics
NPI:1700078896
Name:DURKIN, TIMOTHY JAMES (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JAMES
Last Name:DURKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:J
Other - Last Name:DURKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 160
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-0160
Mailing Address - Country:US
Mailing Address - Phone:505-368-6001
Mailing Address - Fax:
Practice Address - Street 1:2300 E 30TH ST STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-208-6280
Practice Address - Fax:505-564-3202
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14541207P00000X
COCDRH.0055714207PS0010X
NMA-1501-09207PS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJA162ZOtherMEDICARE PTAN
FL021275800Medicaid
CO444557TLKWMedicare PIN