Provider Demographics
NPI:1295753887
Name:DUCKER, THOMAS EDWIN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWIN
Last Name:DUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1001 WATER ST
Mailing Address - Street 2:STE D-200
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3566
Mailing Address - Country:US
Mailing Address - Phone:830-895-5005
Mailing Address - Fax:830-896-4747
Practice Address - Street 1:1001 WATER ST
Practice Address - Street 2:STE D-200
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3566
Practice Address - Country:US
Practice Address - Phone:830-896-5005
Practice Address - Fax:830-896-4747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9895207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136809405Medicaid
TX136809405Medicaid
TXF13679Medicare UPIN