Healthcare Provider Details

I. General information

NPI: 1720055791
Provider Name (Legal Business Name): RICARDO E DUQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 US HIGHWAY 98 S SUITE 101
LAKELAND FL
33801-5852
US

IV. Provider business mailing address

1125 US HIGHWAY 98 S SUITE 101
LAKELAND FL
33801-5852
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-7171
  • Fax: 863-687-0742
Mailing address:
  • Phone: 863-683-7171
  • Fax: 863-687-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME0027370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: