Provider Demographics
NPI:1477577708
Name:DUKE, SUSAN E (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:DUKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W NETTLE CT
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8097
Mailing Address - Country:US
Mailing Address - Phone:214-326-7743
Mailing Address - Fax:
Practice Address - Street 1:1200 W NETTLE CT
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8097
Practice Address - Country:US
Practice Address - Phone:214-326-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H51706Medicare UPIN