Healthcare Provider Details

I. General information

NPI: 1750461828
Provider Name (Legal Business Name): DUANE LEROY HASKELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E COURT ST
PARIS IL
61944-2460
US

IV. Provider business mailing address

727 E COURT ST
PARIS IL
61944-2460
US

V. Phone/Fax

Practice location:
  • Phone: 217-465-8411
  • Fax: 217-463-3814
Mailing address:
  • Phone: 217-465-8411
  • Fax: 217-463-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: