Healthcare Provider Details

I. General information

NPI: 1023115664
Provider Name (Legal Business Name): ELIZABETH DUQUE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11050 MT BELVEDERE BLVD
FORT DRUM NY
13602-2603
US

IV. Provider business mailing address

11050 MT BELVEDERE BLVD
FORT DRUM NY
13602-2603
US

V. Phone/Fax

Practice location:
  • Phone: 888-838-1303
  • Fax:
Mailing address:
  • Phone: 888-838-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number0106437A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0106437A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: