Healthcare Provider Details

I. General information

NPI: 1699239145
Provider Name (Legal Business Name): MICHAEL DELAUNEY DUKATE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ARCHIE ST
VIDOR TX
77662-4839
US

IV. Provider business mailing address

200 S ARCHIE ST
VIDOR TX
77662-4839
US

V. Phone/Fax

Practice location:
  • Phone: 409-206-8946
  • Fax: 409-206-8947
Mailing address:
  • Phone: 409-206-8946
  • Fax: 409-206-8947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: