# RENATO M DURHAM MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750692570
- **Authorized official:** RENATO M DURHAM MD (PRESIDENT)
- **Authorized official phone:** (321) 254-6218

## Contact information

- **Practice address:** 2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
- **Practice address phone:** (321) 254-6218
- **Practice address fax:** (321) 254-6230
- **Mailing address:** 2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
- **Mailing address phone:** (321) 254-6218
- **Mailing address fax:** (321) 254-6230

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | ME67647 | FL | Yes |

## Other

- **Enumeration date:** 06/25/2010
- **Last updated:** 06/25/2010