Healthcare Provider Details

I. General information

NPI: 1326976564
Provider Name (Legal Business Name): LAURA ELISA DUSSAN DUQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N CAMPBELL AVE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

10600 CHESTER AVE APT 1717
CLEVELAND OH
44106-0219
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-6010
  • Fax: 520-626-1446
Mailing address:
  • Phone: 786-762-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR82576
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: