| Doctor Name: | DR. SAMUEL JEROME DURHAM |
| NPI Number: | 1467459040 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 65938 |
| Business Practice Address: | 2500 Niles Rd Ste 6 St Joseph, MI - 49085 |
| Business Phone Number: | 2694081660 |
| Business Fax Number: | 2694081665 |
| Mailing Address: | 2500 Niles Rd Ste 6, ST JOSEPH |
| State: | MI |
| Postal Code: | 49085 |
| Phone Number: | 2694081660 |
| Fax Number: | 2694081665 |
| NPI Enumeration Date: | 06/28/2005 |
| NPI Last Update Date: | 10/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0129X |
| License Number: | 65938 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Vascular Surgery |
| Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |