Provider Demographics
NPI:1275597460
Name:DUEY, DUANE ANSEL (ATC-R)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:ANSEL
Last Name:DUEY
Suffix:
Gender:M
Credentials:ATC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-8613
Mailing Address - Country:US
Mailing Address - Phone:503-866-0247
Mailing Address - Fax:
Practice Address - Street 1:930 SW HALL 143A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201
Practice Address - Country:US
Practice Address - Phone:503-725-4073
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT-AT-221980390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program