Provider Demographics
NPI:1194770776
Name:DURDEN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DURDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32302-1678
Mailing Address - Country:US
Mailing Address - Phone:850-878-4102
Mailing Address - Fax:850-942-4155
Practice Address - Street 1:1600 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5304
Practice Address - Country:US
Practice Address - Phone:850-878-4127
Practice Address - Fax:850-878-0337
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME822612085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000910236AMedicaid
GA000910236CMedicaid
FL261324700Medicaid
GA000910236BMedicaid
FL58833OtherBCBS
FL58833YMedicare PIN
300121256Medicare PIN
300121259Medicare PIN
FL58833OtherBCBS
H29405Medicare UPIN
FL261324700Medicaid