Provider Demographics
NPI:1073060786
Name:DUQUE, FREDDY (AP)
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:
Last Name:DUQUE
Suffix:
Gender:M
Credentials:AP
Other - Prefix:MR
Other - First Name:FREDDY
Other - Middle Name:
Other - Last Name:DUQUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AP
Mailing Address - Street 1:11282 NW 44TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4266
Mailing Address - Country:US
Mailing Address - Phone:786-547-2091
Mailing Address - Fax:
Practice Address - Street 1:1470 NW 107TH AVE STE A
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:FL
Practice Address - Zip Code:33172-2734
Practice Address - Country:US
Practice Address - Phone:786-547-2091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-3765171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist