Healthcare Provider Details

I. General information

NPI: 1992983159
Provider Name (Legal Business Name): ROBERT MICHAEL DUARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OAK PARK BLVD FL 3
LAKE CHARLES LA
70601-8990
US

IV. Provider business mailing address

PO BOX 122165 DEPT 2165
DALLAS TX
75312-2165
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-4900
  • Fax: 337-494-4936
Mailing address:
  • Phone: 337-494-2919
  • Fax: 337-494-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberPGY.1.LSUNO-ORT
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME112558
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD203097
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: