Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 216311 | MA |
Y | 207VX0201X | Gynecologic Oncologist | 216311 | MA |
NPI | 1528041969 |
---|---|
Provider Name | John Durfee |
First Address | Boston, MA 02118 |
Second Address | Boston, MA 02118-2371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 12/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110033593A | (05) | MA |
G21333 | (02) | MA |
UX0120 | MEDICARE ID (01) | MA |