Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | 7228 | TX |
Y | 213ER0200X | Radiology | 7228 | TX |
NPI | 1386647774 |
---|---|
Provider Name | Dr. Raymond T. Durham |
First Address | Georgetown, TX 78628-4484 |
Second Address | Georgetown, TX 78628-4484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 15/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
605681 | BLUECROSS BLUESHIELD TX (01) | TX |
667532 | ACN GROUP (01) | TX |
8265913 | BLUE LINK (01) | TX |
DC7228 | CHIROPRACTIC LICENSE (01) | TX |
U65913 | (02) | TX |