Provider Demographics
NPI:1790771095
Name:DUNCAN, JOHNNY D (DO)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:D
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:DO
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 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:3201 W GORE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6350
Practice Address - Country:US
Practice Address - Phone:805-250-6659
Practice Address - Fax:580-250-5249
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3110207T00000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK175194701OtherDOL
OK5959599OtherAETNA
OK100765610BMedicaid
140007299OtherRAILROAD MEDICARE
OK5959599OtherAETNA
G69764Medicare UPIN