Basic Information
| Provider Information | |||||||||
| NPI: | 1093772089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURAN | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 825 N GRAND AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856211061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202811550 | ||||||||
| FaxNumber: | 5202811112 | ||||||||
| Practice Location | |||||||||
| Address1: | 1209 W TARGET RANGE RD | ||||||||
| Address2: | |||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856212466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202874747 | ||||||||
| FaxNumber: | 5202811112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 14385AZ | AZ | N | Other Service Providers | Specialist | 207VX0000X | 14385 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 245648 | 05 | AZ | MEDICAID | 4045627 | 01 | AZ | AETNA PPO | OTHER | 0183670 | 01 | AZ | ASBAIT AEI | OTHER | AZ0183670 | 01 | AZ | BCBS | OTHER | 1Z1662 | 01 | AZ | HEALTHNET | OTHER | 860587287002 | 01 | AZ | TRICARE | OTHER | 3323971004 | 01 | AZ | CIGNA | OTHER | 627124 | 01 | AZ | AETNA HMO | OTHER |