Provider Demographics
NPI:1750572103
Name:DURE, JEAN MAURICE (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MAURICE
Last Name:DURE
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 1:9816 SW 150TH RUN
Mailing Address - Street 2:
Mailing Address - City:LAKE BUTLER
Mailing Address - State:FL
Mailing Address - Zip Code:32054-7120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-964-3829
Practice Address - Street 1:1200 NE 55TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-2783
Practice Address - Country:US
Practice Address - Phone:904-964-7732
Practice Address - Fax:904-964-3829
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16163208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR039796800Medicaid
FL009635300Medicaid