Provider Demographics
NPI:1427030311
Name:DUARTE, WILLIAM B (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:DUARTE
Suffix:
Gender:M
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 MAGONE LN
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2442
Mailing Address - Country:US
Mailing Address - Phone:503-777-1563
Mailing Address - Fax:503-777-1563
Practice Address - Street 1:7928 SE HARRISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-4134
Practice Address - Country:US
Practice Address - Phone:503-777-1563
Practice Address - Fax:503-777-1563
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150535OtherOMAP