Provider Demographics
NPI:1043605066
Name:DURAN, MARCO (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:
Last Name:DURAN
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 1:4881 E GRANT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2704
Mailing Address - Country:US
Mailing Address - Phone:520-318-6035
Mailing Address - Fax:520-829-6661
Practice Address - Street 1:7140 E ROSEWOOD ST STE 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1346
Practice Address - Country:US
Practice Address - Phone:520-318-6035
Practice Address - Fax:520-829-6661
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60364207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ007542Medicaid