Provider Demographics
NPI:1922377274
Name:DUOCORP ENTERPRISES, LLC
Entity Type:Organization
Organization Name:DUOCORP ENTERPRISES, LLC
Other - Org Name:INNOVATIVE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:417-882-0215
Mailing Address - Street 1:5912 S STOCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7559
Mailing Address - Country:US
Mailing Address - Phone:417-882-0215
Mailing Address - Fax:
Practice Address - Street 1:1525 E REPUBLIC RD
Practice Address - Street 2:SUITE A115
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6527
Practice Address - Country:US
Practice Address - Phone:417-882-0215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006893207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty