Basic Information
| Provider Information | |||||||||
| NPI: | 1467667626 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOSE I DURAN MD PC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | THE WOMEN'S CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 494 N CARONDELET DR | ||||||||
| Address2: | |||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856212453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207611603 | ||||||||
| FaxNumber: | 5202874471 | ||||||||
| Practice Location | |||||||||
| Address1: | 494 N. CARONDELET DR. | ||||||||
| Address2: | |||||||||
| City: | NOGALES | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856212453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207611603 | ||||||||
| FaxNumber: | 5202874471 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 08/15/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DURAN | ||||||||
| AuthorizedOfficialFirstName: | JOSE | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5207611603 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 14385AZ | AZ | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 61101 | 01 | AZ | HUMANA | OTHER | AZ0183670 | 01 | AZ | BCBS | OTHER | 245648 | 05 | AZ | MEDICAID | 4045627 | 01 | AZ | AETNA PPO | OTHER | 91151 | 01 | AZ | STERLING | OTHER | 627124 | 01 | AZ | AETNA HMO | OTHER | 1Z1662 | 01 | AZ | HEALTHNET | OTHER | 3323971004 | 01 | AZ | CIGNA | OTHER | AZ0183670 | 01 | AZ | ASBAIT | OTHER | Z67249 | 01 | MEDICARE | OTHER |