Provider Demographics
NPI:1194931089
Name:DURAN, MIGUEL ISAAC (OTD, MSRS, OTR)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ISAAC
Last Name:DURAN
Suffix:
Gender:
Credentials:OTD, MSRS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ANTLER CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2259
Mailing Address - Country:US
Mailing Address - Phone:210-402-1526
Mailing Address - Fax:325-597-1713
Practice Address - Street 1:13333 BLANCO RD STE 310
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-479-5875
Practice Address - Fax:210-479-2911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107269171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor