Healthcare Provider Details

I. General information

NPI: 1487826947
Provider Name (Legal Business Name): JOHN PAUL DUQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N
PARRISH FL
34219-8410
US

IV. Provider business mailing address

PO BOX 997
PALMETTO FL
34220-0997
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4000
  • Fax: 941-776-4013
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-776-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME102127
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: