Provider Demographics
NPI:1710987409
Name:DUKE, PENELOPE (MD)
Entity Type:Individual
Prefix:
First Name:PENELOPE
Middle Name:
Last Name:DUKE
Suffix:
Gender:F
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:PO BOX 1988
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77410-1988
Mailing Address - Country:US
Mailing Address - Phone:281-345-2743
Mailing Address - Fax:
Practice Address - Street 1:11250 FALLBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4229
Practice Address - Country:US
Practice Address - Phone:281-345-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6180207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129636006Medicaid
TX129636006Medicaid
TXF31518Medicare UPIN