Provider Demographics
NPI:1538139258
Name:DUQUETTE, RUSSELL CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CHARLES
Last Name:DUQUETTE
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 1:2901 NORTH CENTRAL AVE
Mailing Address - Street 2:STE 500
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2738
Mailing Address - Country:US
Mailing Address - Phone:602-744-4765
Mailing Address - Fax:602-744-4799
Practice Address - Street 1:2901 NORTH CENTRAL AVE
Practice Address - Street 2:STE 500
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2738
Practice Address - Country:US
Practice Address - Phone:602-262-8900
Practice Address - Fax:602-262-8919
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13444207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246430Medicaid
C99404Medicare UPIN
AZ101591Medicare ID - Type Unspecified