Individual
DR. JERRY FRED DURIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 S MERIDIAN, SUITE A, PUYALLUP, WA 98371-6995
(253) 845-6645
(253) 770-2295
Mailing address
3908 10TH ST SE, PUYALLUP, WA 98374-2188
(253) 848-5951
(253) 845-7073
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00026703
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1052802
—
WA
01
—
110099728
MEDICARE OTHER-INDIVIDUAL
WA
01
—
CO3401
MEDICARE OTHER-GROUP
WA
Enumeration date
12/05/2006
Last updated
01/02/2020
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