Provider Demographics
NPI:1851322077
Name:DUKE, BRUCE E III (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:DUKE
Suffix:III
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 1:1086 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4305
Mailing Address - Country:US
Mailing Address - Phone:814-410-8300
Mailing Address - Fax:814-410-8331
Practice Address - Street 1:1015 FRANKLIN ST
Practice Address - Street 2:LEVEL C, WESSEL BLDG
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4110
Practice Address - Country:US
Practice Address - Phone:814-539-8725
Practice Address - Fax:814-539-6336
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010941E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006412670004Medicaid
PAB35473Medicare UPIN
PA090936Medicare PIN