Organization
DOCTORS CLINIC OF DURANT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOTESWAR RAO SUREDDI MD (OWNER)
(580) 924-1700
Entity
Organization
Contact information
Practice address
1400 BRYAN DR, SUITE 300, DURANT, OK 74701-2156
(580) 924-1700
(580) 924-1736
Mailing address
1400 BRYAN DR, SUITE 300, DURANT, OK 74701
(580) 924-1700
(580) 924-1736
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11978
OK
207R00000X
Internal Medicine Physician
23224
OK
207VG0400X
Gynecology Physician
11979
OK
261QM2500X
Medical Specialty Clinic/Center
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177390A
—
OK
05
—
100733950B
—
OK
05
—
200076210G
—
OK
Enumeration date
10/04/2006
Last updated
12/10/2010
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