Healthcare Provider Details

I. General information

NPI: 1063481190
Provider Name (Legal Business Name): THOMAS P DUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SHERMAN ST STE 100
SAINT PAUL MN
55102-2401
US

IV. Provider business mailing address

345 SHERMAN ST STE 100
SAINT PAUL MN
55102-2401
US

V. Phone/Fax

Practice location:
  • Phone: 651-251-5500
  • Fax: 651-251-5555
Mailing address:
  • Phone: 651-251-5500
  • Fax: 651-251-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number32853
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: