Individual
CHARLES RUSSELL DURR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
11375 CORTEZ BLVD, BROOKSVILLE, FL 34613-5409
(352) 569-6632
Mailing address
21130 MARGUERITE RD, BROOKSVILLE, FL 34601-1643
(352) 796-1743
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1826
FL
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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