Provider Demographics
NPI:1326005190
Name:DURHAM, MICHEAL J (DO)
Entity type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:J
Last Name:DURHAM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:54 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3050
Mailing Address - Country:US
Mailing Address - Phone:573-348-8000
Mailing Address - Fax:
Practice Address - Street 1:755 COWAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4629
Practice Address - Country:US
Practice Address - Phone:417-532-2805
Practice Address - Fax:417-532-2848
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4291207Q00000X
MO2010019729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326005190Medicaid