Healthcare Provider Details

I. General information

NPI: 1033621719
Provider Name (Legal Business Name): DUKE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 CREEKSTONE DRIVE SUITE 105
DURHAM NC
27703
US

IV. Provider business mailing address

2200 WEST MAIN STREET SUITE 400A
DURHAM NC
27705
US

V. Phone/Fax

Practice location:
  • Phone: 919-941-0407
  • Fax: 919-941-9173
Mailing address:
  • Phone: 919-286-3232
  • Fax: 919-286-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES SCOTT GIBSON
Title or Position: DUKE UNIV. SOP EXEC. VICE DEAN FOR
Credential: M.B.A
Phone: 919-684-3945