Organization
RENATO M DURHAM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENATO M DURHAM MD (PRESIDENT)
(321) 254-6218
Entity
Organization
Contact information
Practice address
2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
(321) 254-6218
(321) 254-6230
Mailing address
2080 W EAU GALLIE BLVD, MELBOURNE, FL 32935-3185
(321) 254-6218
(321) 254-6230
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
ME67647
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
758961100
—
FL
Enumeration date
06/25/2010
Last updated
06/25/2010
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