Healthcare Provider Details

I. General information

NPI: 1336188093
Provider Name (Legal Business Name): IRENE S DUARTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 W HOSPITAL DR STE 255 NORTHWEST MEDICAL GROUP
TUCSON AZ
85704-7857
US

IV. Provider business mailing address

5055 E BROADWAY BLVD STE A100 ARIZONA COMMUNITY PHYSICIAN PC
TUCSON AZ
85711-3629
US

V. Phone/Fax

Practice location:
  • Phone: 520-547-5725
  • Fax: 520-547-5735
Mailing address:
  • Phone: 520-547-4906
  • Fax: 520-795-0225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21997
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: