Provider Demographics
NPI:1295710747
Name:DUQUE, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DUQUE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:480 4TH AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-4410
Mailing Address - Country:US
Mailing Address - Phone:619-691-0240
Mailing Address - Fax:619-691-8804
Practice Address - Street 1:480 4TH AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4410
Practice Address - Country:US
Practice Address - Phone:619-691-0240
Practice Address - Fax:619-691-8804
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2013-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG48442207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G484420Medicaid
CAA51059Medicare UPIN
CA00G484420Medicaid