Healthcare Provider Details

I. General information

NPI: 1417966607
Provider Name (Legal Business Name): KATHLEEN MARIE DUERKSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5979 E GRANT RD SUITE 115
TUCSON AZ
85712
US

IV. Provider business mailing address

5979 E GRANT RD SUITE 115
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-751-8030
  • Fax: 520-751-0990
Mailing address:
  • Phone: 520-751-8030
  • Fax: 520-751-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number21767
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: