Basic Information
| Provider Information | |||||||||
| NPI: | 1487662573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURKIN | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2410 SAMARITAN DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083710390 | ||||||||
| FaxNumber: | 4083710462 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 SAMARITAN DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083710728 | ||||||||
| FaxNumber: | 4083711164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 2085N0904X | A21883 | CA | X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | A21883 | CA | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00A218830 | 05 | CA | MEDICAID |