Healthcare Provider Details

I. General information

NPI: 1720039274
Provider Name (Legal Business Name): JOSE A DUARTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N BUCKNER BLVD SUITE 100
DALLAS TX
75218-3487
US

IV. Provider business mailing address

PO BOX 140105
DALLAS TX
75214-0105
US

V. Phone/Fax

Practice location:
  • Phone: 214-324-9400
  • Fax: 214-324-9402
Mailing address:
  • Phone: 214-522-0210
  • Fax: 214-522-0474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH2348
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: