Provider Demographics
NPI:1053374710
Name:DURRETT, ROBIN D (DO)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:DURRETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-1440
Mailing Address - Country:US
Mailing Address - Phone:620-564-3771
Mailing Address - Fax:620-564-2684
Practice Address - Street 1:611 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1440
Practice Address - Country:US
Practice Address - Phone:620-564-3771
Practice Address - Fax:620-564-2684
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-25299208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100159620DMedicaid
KS1053374710Medicare PIN
KS100159620CMedicaid
KSF70695Medicare UPIN