Provider Demographics
NPI:1720014566
Name:DUTHIL, MARIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:E
Last Name:DUTHIL
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 1:279 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:PAHOKEE
Mailing Address - State:FL
Mailing Address - Zip Code:33476
Mailing Address - Country:US
Mailing Address - Phone:561-446-4312
Mailing Address - Fax:866-611-0620
Practice Address - Street 1:279 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:PAHOKEE
Practice Address - State:FL
Practice Address - Zip Code:33476
Practice Address - Country:US
Practice Address - Phone:561-446-4312
Practice Address - Fax:866-611-0620
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257949900Medicaid
FLF35263Medicare UPIN