Provider Demographics
NPI:1528539756
Name:DURHAM, JOE CALVIN II (IDMT)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:CALVIN
Last Name:DURHAM
Suffix:II
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 23
Mailing Address - Street 2:
Mailing Address - City:HOLLOMAN AFB
Mailing Address - State:NM
Mailing Address - Zip Code:88330
Mailing Address - Country:US
Mailing Address - Phone:572-575-1816
Mailing Address - Fax:
Practice Address - Street 1:49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 23
Practice Address - Street 2:
Practice Address - City:HOLLOMAN AFB
Practice Address - State:NM
Practice Address - Zip Code:88330
Practice Address - Country:US
Practice Address - Phone:572-575-1816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians