Provider Demographics
NPI:1487640884
Name:DURET, EDOUARD J (MD)
Entity type:Individual
Prefix:MR
First Name:EDOUARD
Middle Name:J
Last Name:DURET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 1ST AVE N
Mailing Address - Street 2:PO DRAWER N
Mailing Address - City:ILWACO
Mailing Address - State:WA
Mailing Address - Zip Code:98624
Mailing Address - Country:US
Mailing Address - Phone:360-642-3747
Mailing Address - Fax:360-642-3361
Practice Address - Street 1:176 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ILWACO
Practice Address - State:WA
Practice Address - Zip Code:98624
Practice Address - Country:US
Practice Address - Phone:360-642-3747
Practice Address - Fax:360-642-3361
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036757208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADU7152OtherBCBS
WA111916OtherL & I
WA8233090Medicaid
WA8233090Medicaid
C45513Medicare UPIN