Provider Demographics
NPI:1528096195
Name:DURIE, WILLIAM JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:DURIE
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 1:5219 SAINT JOHN DR
Mailing Address - Street 2:
Mailing Address - City:ORR
Mailing Address - State:MN
Mailing Address - Zip Code:55771-8232
Mailing Address - Country:US
Mailing Address - Phone:218-757-3650
Mailing Address - Fax:218-757-0234
Practice Address - Street 1:5219 SAINT JOHN DR
Practice Address - Street 2:
Practice Address - City:ORR
Practice Address - State:MN
Practice Address - Zip Code:55771-8232
Practice Address - Country:US
Practice Address - Phone:218-757-3650
Practice Address - Fax:218-757-0234
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN173821600Medicaid
MN080009092Medicare PIN
G40517Medicare UPIN