Provider Demographics
NPI:1760452247
Name:DUNCAN, DEBORAH L (MD)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:DUNCAN
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 1:13311 OLD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9498
Mailing Address - Country:US
Mailing Address - Phone:810-629-4831
Mailing Address - Fax:
Practice Address - Street 1:102 N ADELAIDE ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2670
Practice Address - Country:US
Practice Address - Phone:810-629-2245
Practice Address - Fax:810-629-6535
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381746096OtherFEDERAL TAX ID # FOR GROU
MI080015597OtherMEDICARE RAILROAD ID NUMB
MI1002567OtherMCLAREN HEALTH PLAN ID #
MI1023526096OtherHEALTHPLUS ID NUMBER
MI2640376Medicaid
MI0B56256005OtherMEDICARE ID NUMBER
MI0253709OtherBCBS AND BCN PIN NUMBER
MI080015597OtherMEDICARE RAILROAD ID NUMB