Provider Demographics
NPI:1700932308
Name:DURBIN, RONALD REID III (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:REID
Last Name:DURBIN
Suffix:III
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 1:6600 VAN AALST BLVD # 2A-124
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:762-408-3565
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD # 2A-124
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:762-408-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT045691208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2V9940OtherHEALTHNET
CT8221524OtherCIGNA
CT045691OtherCT CARE
CT010045691CT01OtherANTHEM
CT001456913Medicaid
CT060916029OtherTAX ID NUMBER
CTP00454522Medicare PIN
CT2V9940OtherHEALTHNET