MEDICARE: DR. WILLIAM B DUARTE DAOM, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00214	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	150535	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1427030311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM B DUARTE DAOM, LAC

Provider Business Mailing Address
First Line	:	2710 MAGONE LN
Second Line	:
City	:	WEST LINN
State	:	OR
Zip	:	97068-2442
Country	:	US
Telephone Number	:	503-777-1563
Fax Number	:	503-777-1563

Provider Business Practice Location Address
First Line	:	7928 SE HARRISON ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97215-4134
Country	:	US
Telephone Number	:	503-777-1563
Fax Number	:	503-777-1563

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/08/2007

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