Healthcare Provider Details

I. General information

NPI: 1922377274
Provider Name (Legal Business Name): DUOCORP ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E REPUBLIC RD SUITE A115
SPRINGFIELD MO
65804-6527
US

IV. Provider business mailing address

5912 S STOCKTON AVE
SPRINGFIELD MO
65804-7559
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-0215
  • Fax:
Mailing address:
  • Phone: 417-882-0215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2007006893
License Number StateMO

VIII. Authorized Official

Name: DR. JEREMY J REED
Title or Position: PRESIDENT
Credential: D.O.
Phone: 417-882-0215