Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D008740 | AZ |
NPI | 1093153058 |
---|---|
Provider Name | James W. Duncan |
First Address | Nogales, AZ 85621-1063 |
Second Address | Nogales, AZ 85621-1063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 11/06/2013 |