Healthcare Provider Details

I. General information

NPI: 1992779250
Provider Name (Legal Business Name): MATTHEW DUKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 N MILLER RD
BUCKEYE AZ
85326-1043
US

IV. Provider business mailing address

9250 N. 3RD ST SUITE 4010
PHOENIX AZ
85020
US

V. Phone/Fax

Practice location:
  • Phone: 623-386-5785
  • Fax: 623-386-6673
Mailing address:
  • Phone: 602-633-3848
  • Fax: 602-633-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3481
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: