Provider Demographics
NPI:1912099383
Name:DURAN, WAYNE MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MARK
Last Name:DURAN
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:PO BOX 1237
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-1237
Mailing Address - Country:US
Mailing Address - Phone:253-288-8882
Mailing Address - Fax:253-288-2283
Practice Address - Street 1:1402 LAKE TAPPS PKWY E
Practice Address - Street 2:SUITE F106
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-8157
Practice Address - Country:US
Practice Address - Phone:253-288-8882
Practice Address - Fax:253-288-2283
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00020201305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA08902Medicare UPIN