Provider Demographics
NPI:1336589779
Name:DUARTE OW, JOAQUIN ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:ALBERTO
Last Name:DUARTE OW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOAQUIN
Other - Middle Name:ALBERTO
Other - Last Name:DUARTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9419
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-30
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28558207R00000X
TN61158207R00000X
ARE-9940207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine