Provider Demographics
NPI:1518908854
Name:DUNCAN, ULRIC DAVE (MD)
Entity Type:Individual
Prefix:
First Name:ULRIC
Middle Name:DAVE
Last Name:DUNCAN
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 1:9140 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-1233
Mailing Address - Country:US
Mailing Address - Phone:662-510-0696
Mailing Address - Fax:662-280-5541
Practice Address - Street 1:9140 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-1233
Practice Address - Country:US
Practice Address - Phone:662-280-8222
Practice Address - Fax:662-280-5541
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3050626OtherBCBS TN
MS00119038Medicaid
TN4045819Medicaid
MSF96919Medicare UPIN
TN4045819Medicaid