Provider Demographics
NPI:1013964105
Name:DUVIC, MADELEINE (MD)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:DUVIC
Suffix:
Gender:F
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:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:713-524-3432
Practice Address - Street 1:6655 TRAVIS ST
Practice Address - Street 2:600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1312
Practice Address - Country:US
Practice Address - Phone:713-500-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7201207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132116801OtherCSHCN
TX87X442OtherBCBCTX
TX132116805Medicaid
TX132116805Medicaid
B22413Medicare UPIN
TX87X442Medicare PIN