Provider Demographics
NPI:1134395072
Name:DUKE, J. DOUGLAS II (DO)
Entity type:Individual
Prefix:
First Name:J.
Middle Name:DOUGLAS
Last Name:DUKE
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:DOUG
Other - Middle Name:
Other - Last Name:DUKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2967 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1119
Mailing Address - Country:US
Mailing Address - Phone:334-305-2085
Mailing Address - Fax:
Practice Address - Street 1:2967 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1119
Practice Address - Country:US
Practice Address - Phone:334-305-2085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE7290208600000X
ALDO.1390208600000X, 207Q00000X
OK4365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALDO.1390OtherSTATE MEDICAL LICENSE
OK200201300AMedicaid
AR5AN30Medicare PIN