Provider Demographics
NPI:1821782301
Name:CONTRERAS DUARTE, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:CONTRERAS DUARTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269 W ELLIS ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2270
Mailing Address - Country:US
Mailing Address - Phone:520-285-7567
Mailing Address - Fax:
Practice Address - Street 1:2727 W BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1067
Practice Address - Country:US
Practice Address - Phone:602-276-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR79735207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine