Basic Information
| Provider Information | |||||||||
| NPI: | 1487640884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURET | ||||||||
| FirstName: | EDOUARD | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 176 1ST AVE N | ||||||||
| Address2: | PO DRAWER N | ||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
| FaxNumber: | 3606423361 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 1ST AVE N | ||||||||
| Address2: | |||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
| FaxNumber: | 3606423361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD00036757 | WA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | DU7152 | 01 | WA | BCBS | OTHER | 111916 | 01 | WA | L & I | OTHER | 8233090 | 05 | WA | MEDICAID |