Provider Demographics
NPI:1932547338
Name:DURST, PAULA JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:JEAN
Last Name:DURST
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642
Mailing Address - Country:US
Mailing Address - Phone:208-467-4555
Mailing Address - Fax:208-302-1255
Practice Address - Street 1:1055 N CURTIS RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706
Practice Address - Country:US
Practice Address - Phone:208-467-4555
Practice Address - Fax:208-302-1255
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1050207V00000X, 208M00000X
IN11017243A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology