Provider Demographics
NPI:1689632085
Name:DUNCAN, CLINTON ERIC (PA)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:ERIC
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:PA
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 86144
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-6144
Mailing Address - Country:US
Mailing Address - Phone:251-476-5050
Mailing Address - Fax:251-450-2770
Practice Address - Street 1:6144 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3143
Practice Address - Country:US
Practice Address - Phone:251-476-5050
Practice Address - Fax:251-450-2770
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-132363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51532171OtherBCBS OF AL
AL5514653OtherAETNA
AL009935721Medicaid
ALP00332004OtherRR MEDICARE
631187140OtherTAX ID
ALS09874OtherVIVA
AL051532171Medicare PIN