Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2010035671 | MO |
NPI | 1003092057 |
---|---|
Provider Name | Dr. Douglas Don Durand |
First Address | Washington, MO 63090 |
Second Address | Washington, MO 63090 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2008 |
Last Update Date | 10/01/2011 |