Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 02002205A | IN |
Y | 111NI0900X | Internist | 02002205A | IN |
N | 207RG0300X | Geriatric Medicine | 02002205A | IN |
N | 207RH0002X | Hospice and Palliative Medicine | 02002205 | IN |
NPI | 1023098639 |
---|---|
Provider Name | Tammy N Durham-Boring |
First Address | Indianapolis, IN 46250-2805 |
Second Address | Fishers, IN 46037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 22/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000714181 | ANTHEM (01) | |
200266500 | (05) | IN |
H09680 | (02) | |
P01424312 | RR MEDICARE (01) | IN |