Provider Demographics
NPI:1548585383
Name:DUNCAN, DARREN SHAWN (CERTIFIRED 1ST ASSIS)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:SHAWN
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:CERTIFIRED 1ST ASSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 WILD WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-6027
Mailing Address - Country:US
Mailing Address - Phone:502-640-7656
Mailing Address - Fax:
Practice Address - Street 1:229 WILD WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-6027
Practice Address - Country:US
Practice Address - Phone:502-640-7656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA211246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant