Provider Demographics
NPI:1750650099
Name:DUERKES, MICHAEL ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROBERT
Last Name:DUERKES
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:915 TATE BLVD SE STE 190
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4042
Mailing Address - Country:US
Mailing Address - Phone:828-294-7793
Mailing Address - Fax:828-330-2060
Practice Address - Street 1:503 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5104
Practice Address - Country:US
Practice Address - Phone:828-437-6500
Practice Address - Fax:828-330-2048
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2022-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03215363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750650099Medicaid