Provider Demographics
NPI:1720400401
Name:WILBUR DON DUQUE MD PC
Entity Type:Organization
Organization Name:WILBUR DON DUQUE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICIER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:DON
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-783-4826
Mailing Address - Street 1:2244 S AVENUE A
Mailing Address - Street 2:SUITE E
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8341
Mailing Address - Country:US
Mailing Address - Phone:928-783-4826
Mailing Address - Fax:
Practice Address - Street 1:2244 S AVENUE A
Practice Address - Street 2:SUITE E
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8341
Practice Address - Country:US
Practice Address - Phone:928-783-4826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1548464100Medicare UPIN