Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 13608 | TX |
N | 1223P0300X | Periodontist | 13608 | TX |
NPI | 1154394120 |
---|---|
Provider Name | Randall Craig Duncan |
First Address | Peterson Afb, CO 80914-1540 |
Second Address | Peterson Air Force Base, CO 80914-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |