MEDICARE: DR. BILLY LEE DUKE II MD

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	207VM0101X	Maternal & Fetal Medicine Physician	MD35803	TN
2	207V00000X	Obstetrics & Gynecology Physician	ME102267	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1051926	OTHER	TN	CIGNA
2	4071531	OTHER	TN	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	5339029	OTHER	TN	AETNA HMO/PPO

General Provider Information

NPI Number	:	1861479354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BILLY LEE DUKE II MD

Provider Business Mailing Address
First Line	:	225 WAYNE AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3149
Country	:	US
Telephone Number	:	321-615-1744
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 WAYNE AVE
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3149
Country	:	US
Telephone Number	:	321-615-1744
Fax Number	:

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	02/16/2010

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