Basic Information
Provider Information | |||||||||
NPI: | 1992904775 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DURING | ||||||||
FirstName: | ADELAIDE | ||||||||
MiddleName: | W | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 10402 MISSY RIDGE CT | ||||||||
Address2: |   | ||||||||
City: | CYPRESS | ||||||||
State: | TX | ||||||||
PostalCode: | 774330150 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6672240799 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 22999 US-59 N | ||||||||
Address2: |   | ||||||||
City: | KINGWOOD | ||||||||
State: | TX | ||||||||
PostalCode: | 77433 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2813488000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2007 | ||||||||
LastUpdateDate: | 10/17/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0102202689 | VA | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | DO034397 | DC | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | H0070050 | MD | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 245119 | NY | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | N3016 | TX | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 419654600 | 05 | MD |   | MEDICAID |