Provider Demographics
NPI:1295868727
Name:DUCKWITZ, DAVID A (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:DUCKWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 FOOTHILL BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4771
Mailing Address - Country:US
Mailing Address - Phone:307-362-9545
Mailing Address - Fax:307-362-9732
Practice Address - Street 1:2631 FOOTHILL BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4771
Practice Address - Country:US
Practice Address - Phone:307-362-9545
Practice Address - Fax:307-362-9732
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY119213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116937800Medicaid
WY116937800Medicaid
WYU86019Medicare UPIN