Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 594025 | TX |
N | 208600000X | Surgeon | 594025 | TX |
N | 208800000X | Urologist | 301446-01 | NY |
Y | 208800000X | Urologist | R7717 | TX |
NPI | 1003295320 |
---|---|
Provider Name | Dr. Trey Dennis Durdin |
First Address | New York, NY 10065-6007 |
Second Address | New York, NY 10065-6007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2015 |
Last Update Date | 02/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
594025 | PHYSICIAN IN TRAINING (01) | TX |