Provider Demographics
NPI:1912168360
Name:CARL E DUKES M D PA
Entity Type:Organization
Organization Name:CARL E DUKES M D PA
Other - Org Name:CARL E DUKES M D PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INTERNAL MEDICINE/NEPHROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-226-1717
Mailing Address - Street 1:2011 E HOUSTON ST
Mailing Address - Street 2:STE 101A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-2916
Mailing Address - Country:US
Mailing Address - Phone:210-226-1717
Mailing Address - Fax:210-226-2132
Practice Address - Street 1:2011 E HOUSTON ST
Practice Address - Street 2:STE 101A
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2916
Practice Address - Country:US
Practice Address - Phone:210-226-1717
Practice Address - Fax:210-226-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8471302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00CU242Medicaid
TX00CU242Medicaid
TX00638YMedicare PIN