Provider Demographics
NPI:1356301147
Name:DUKE, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:DUKE
Suffix:
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 1:705 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR128982001Medicaid
ARG17987Medicare UPIN
AR5J906Medicare ID - Type Unspecified