Provider Demographics
NPI:1093947418
Name:JOHN RICHARD DUKE SR MD PLLC DBA DUKE MEDICAL
Entity Type:Organization
Organization Name:JOHN RICHARD DUKE SR MD PLLC DBA DUKE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:501-268-3853
Mailing Address - Street 1:705 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:501-268-3853
Mailing Address - Fax:501-268-3856
Practice Address - Street 1:705 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6964
Practice Address - Country:US
Practice Address - Phone:501-268-3853
Practice Address - Fax:501-268-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0540261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128982001Medicaid
ARP00205492OtherRR MEDICARE
AR5J906Medicare PIN
ARP00205492OtherRR MEDICARE
AR128982001Medicaid