Organization Name: | KEVIN R DUKE, DO, PC |
NPI Number: | 1003001959 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN R DUKE (OWNER) |
Mailing Address: | 382 W 280 N Providence |
State: | UT US |
Postal Code: | 843320609 |
Phone Number: | 4357520330 |
Fax Number: | 4357550922 |
NPI Enumeration Date: | 09/12/2007 |
NPI Last Update Date: | 12/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QH0100X |
License Number: | 290545-1204 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Health Service |
Taxonomy Definition: |