Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 15019 | NH |
Y | 207VX0000X | Obstetrician | F1520 | TX |
NPI | 1013932540 |
---|---|
Provider Name | John Wakefield Durst |
First Address | The Woodlands, TX 77380-2686 |
Second Address | The Woodlands, TX 77380-3209 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 24/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3113553 | (05) | NH |
B87641 | (02) | TX |