Doctor Name: | DR. JEFFREY R DURBIN |
NPI Number: | 1134161417 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 1887057 |
Business Practice Address: | 500 E Veterans St Tomah, WI - 546603105 |
Business Phone Number: | 6083723971 |
Business Fax Number: | 6083721263 |
Mailing Address: | 11331 Flavone Rd, TOMAH |
State: | WI |
Postal Code: | 546608175 |
Phone Number: | 6083742403 |
Fax Number: | |
NPI Enumeration Date: | 06/12/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1887057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |