Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 7012097 | ZZ |
NPI | 1356970768 |
---|---|
Provider Name | Dr. Jonathan Howard Durell |
First Address | Lewisville, TX 75067-7461 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2020 |
Last Update Date | 07/04/2020 |