Provider Demographics
NPI:1003151424
Name:DUNCAN RHEUMATOLOGY CENTER, PLLC
Entity type:Organization
Organization Name:DUNCAN RHEUMATOLOGY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-623-3307
Mailing Address - Street 1:1509 BROOKWOOD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1315
Mailing Address - Country:US
Mailing Address - Phone:580-786-4590
Mailing Address - Fax:580-786-4593
Practice Address - Street 1:1509 BROOKWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1315
Practice Address - Country:US
Practice Address - Phone:580-786-4590
Practice Address - Fax:580-786-4593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22384207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200469260AMedicaid
OK271509Medicare PIN