Provider Demographics
NPI:1649360728
Name:DURBORAW, CATHERINE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ELIZABETH
Last Name:DURBORAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 E SUNNYSIDE RD STE G
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8281
Mailing Address - Country:US
Mailing Address - Phone:208-529-8232
Mailing Address - Fax:208-542-1150
Practice Address - Street 1:2375 E SUNNYSIDE RD STE G
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8281
Practice Address - Country:US
Practice Address - Phone:208-529-8232
Practice Address - Fax:208-542-1150
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-74572086S0122X
IDM7457207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004698OtherREGENCE BLUE SHIELD OF ID
IDDV336OtherBLUE CROSS OF IDAHO
IDDV336OtherBLUE CROSS OF IDAHO
IDG49373Medicare UPIN
ID1139956Medicare ID - Type Unspecified