Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | A74218 | CA |
NPI | 1013986959 |
---|---|
Provider Name | Andrew Duke |
First Address | Riverside, CA 92506-3912 |
Second Address | Riverside, CA 92506-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I40834 | (02) | CA |
ZZZ31887Z | SITE PTAN (01) | CA |