Provider Demographics
NPI:1588673008
Name:MISHRA, DURBA (MD)
Entity type:Individual
Prefix:
First Name:DURBA
Middle Name:
Last Name:MISHRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 S PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4915
Mailing Address - Country:US
Mailing Address - Phone:409-384-9200
Mailing Address - Fax:409-384-9205
Practice Address - Street 1:1273 S PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-4915
Practice Address - Country:US
Practice Address - Phone:409-384-9200
Practice Address - Fax:409-384-9205
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0429207R00000X, 207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031495701Medicaid
TX031495705Medicaid
TXH23784Medicare UPIN