Provider Demographics
NPI:1467447623
Name:DUENO, OTTO R (MD)
Entity Type:Individual
Prefix:DR
First Name:OTTO
Middle Name:R
Last Name:DUENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 CEDAR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:OH
Mailing Address - Zip Code:45370-9783
Mailing Address - Country:US
Mailing Address - Phone:937-848-3729
Mailing Address - Fax:
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE G-3
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-281-0900
Practice Address - Fax:937-281-0930
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350665092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0264477Medicaid
OHH069190OtherMEDICARE PTAN
OHPO1068644OtherMEDICARE RAILROAD
OH0264477Medicaid