Healthcare Provider Details

I. General information

NPI: 1134127343
Provider Name (Legal Business Name): DENNIS HOWARD DUCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8731 RUTLEDGE PIKE
RUTLEDGE TN
37861
US

IV. Provider business mailing address

404 GATE ST
JEFFERSON CITY TN
37760-3645
US

V. Phone/Fax

Practice location:
  • Phone: 865-828-5595
  • Fax: 865-828-5607
Mailing address:
  • Phone: 865-475-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD19957
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD19957
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19957
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: