Healthcare Provider Details

I. General information

NPI: 1396936654
Provider Name (Legal Business Name): ALEXIS R DUKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 03/08/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 PROFESSIONAL DR
HOUMA LA
70360
US

IV. Provider business mailing address

12 PROFESSIONAL DR
HOUMA LA
70360
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-1810
  • Fax: 985-868-1810
Mailing address:
  • Phone: 985-868-1810
  • Fax: 985-876-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD.202760
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPGY.1.EKL
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: