Provider Demographics
NPI:1649060815
Name:DUNCAN, OTIS JAMES (MA)
Entity type:Individual
Prefix:MR
First Name:OTIS
Middle Name:JAMES
Last Name:DUNCAN
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:O.J.
Other - Middle Name:
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1181 E WALNUT ST APT 5-4
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5016
Mailing Address - Country:US
Mailing Address - Phone:618-983-9039
Mailing Address - Fax:
Practice Address - Street 1:300 W OAK ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1400
Practice Address - Country:US
Practice Address - Phone:618-536-6621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker