Provider Demographics
NPI:1629121702
Name:MONICK, DUANE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:A
Last Name:MONICK
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 1:406 S 30TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3713
Mailing Address - Country:US
Mailing Address - Phone:509-248-7715
Mailing Address - Fax:509-248-2890
Practice Address - Street 1:406 S 30TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3713
Practice Address - Country:US
Practice Address - Phone:509-248-7715
Practice Address - Fax:509-248-2890
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015120207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1054808Medicaid
WA1054808Medicaid