Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 0101038473 | VA |
NPI | 1013903723 |
---|---|
Provider Name | Paul Frederick Duckworth JR. |
First Address | Richmond, VA 23230-2918 |
Second Address | Mechanicsville, VA 23116-1804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2005 |
Last Update Date | 06/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006073093 | (05) | VA |
B06650 | (02) |