Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD2018-0092 | NM |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD2018-0092 | NM |
NPI | 1336567635 |
---|---|
Provider Name | Dr. John Russell Durkin |
First Address | Albuquerque, NM 87102-2708 |
Second Address | Albuquerque, NM 87102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 10/07/2018 |