Provider Demographics
NPI:1255492211
Name:DUKE, DAVID L III (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:DUKE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632868
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75963-2868
Mailing Address - Country:US
Mailing Address - Phone:936-560-5537
Mailing Address - Fax:
Practice Address - Street 1:1216 RAGUET
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4228
Practice Address - Country:US
Practice Address - Phone:936-560-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2287568OtherBLUE CROSS BLUE SHIELD
TX2287568OtherBLUE CROSS BLUE SHIELD
B87568Medicare UPIN