Provider Demographics
NPI:1194716761
Name:DURO, DEBORA (MD, MS)
Entity type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:
Last Name:DURO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE 3RD AVE
Mailing Address - Street 2:THIRD FLOOR PBO
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2564
Mailing Address - Country:US
Mailing Address - Phone:954-712-6623
Mailing Address - Fax:954-712-6629
Practice Address - Street 1:1625 SE 3RD AVE
Practice Address - Street 2:SUITE 635
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2521
Practice Address - Country:US
Practice Address - Phone:954-712-6623
Practice Address - Fax:954-712-6629
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224131208000000X
FLME905162080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001473700Medicaid
FL001473700Medicaid