MEDICARE: DR. IVORIQUE' CLARK DURU DO

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	207Q00000X	Family Medicine Physician	20A9515	CA
2	207Q00000X	Family Medicine Physician	067099	GA
3	207Q00000X	Family Medicine Physician	OS14611	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922077437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVORIQUE' CLARK DURU DO

Provider Business Mailing Address
First Line	:	73 SPRING TIDE WAY
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-4416
Country	:	US
Telephone Number	:	619-578-3763
Fax Number	:

Provider Business Practice Location Address
First Line	:	2104 MASSEY AVENUE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32228
Country	:	US
Telephone Number	:	904-270-4319
Fax Number	:	904-270-4451

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/21/2025

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