Individual
WILLIAM DURST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
200 HIGH SERVICE AVE, NORTH PROVIDENCE, RI 02904-5113
(401) 456-3402
Mailing address
PO BOX 65377, CHARLOTTE, NC 28265-0377
(800) 377-8721
(304) 523-2241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00028
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27355-0
BCBS
RI
01
—
411611
BLUE CHIP
RI
05
—
9003979
—
RI
01
—
P00216522
RAILROAD
—
Enumeration date
03/22/2006
Last updated
02/14/2012
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