Provider Demographics
NPI:1063440907
Name:DURBIN, DREW ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:ANTHONY
Last Name:DURBIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16601 N 40TH ST
Mailing Address - Street 2:SUITE 119
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3345
Mailing Address - Country:US
Mailing Address - Phone:480-779-4999
Mailing Address - Fax:480-779-4998
Practice Address - Street 1:16601 N 40TH ST
Practice Address - Street 2:SUITE 119
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-3355
Practice Address - Country:US
Practice Address - Phone:480-779-4999
Practice Address - Fax:480-779-4998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
139344Medicare UPIN