Provider Demographics
NPI:1881816734
Name:DUCKWORTH, AMY (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 COYLE AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0363
Mailing Address - Country:US
Mailing Address - Phone:916-965-4000
Mailing Address - Fax:916-965-4813
Practice Address - Street 1:6403 COYLE AVE STE 170
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0363
Practice Address - Country:US
Practice Address - Phone:916-965-4000
Practice Address - Fax:916-965-4813
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4723213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4292600001OtherDME SUPPLIER NUMBER