Provider Demographics
NPI:1629016902
Name:DUKE, WILLIAM JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:DUKE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 104240
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65110-4240
Mailing Address - Country:US
Mailing Address - Phone:573-556-7724
Mailing Address - Fax:573-636-6908
Practice Address - Street 1:1241 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6023
Practice Address - Country:US
Practice Address - Phone:573-556-7724
Practice Address - Fax:573-636-6908
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006008809213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00322862OtherRAILROAD MEDICARE
MO301015202Medicaid
MO0428190006OtherDMERC/NORIDIAN
MOCC7852OtherRR GROUP
MO0428190006OtherDMERC/NORIDIAN
MOV09339Medicare UPIN
MO0428190006Medicare NSC