Provider Demographics
NPI:1861479354
Name:DUKE, BILLY LEE II (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLY
Middle Name:LEE
Last Name:DUKE
Suffix:II
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 1:225 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3149
Mailing Address - Country:US
Mailing Address - Phone:321-615-1744
Mailing Address - Fax:
Practice Address - Street 1:225 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-3149
Practice Address - Country:US
Practice Address - Phone:321-615-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD35803207VM0101X
FLME102267207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1051926OtherCIGNA
TN4071531OtherBLUE CROSS/BLUE SHIELD
TN3878282Medicaid
TN4071531Medicaid
TN5339029OtherAETNA HMO/PPO
TN4071531Medicaid
TN3878283Medicare PIN
TN1051926OtherCIGNA
TN5339029OtherAETNA HMO/PPO
TN3878282Medicaid