Healthcare Provider Details

I. General information

NPI: 1033319702
Provider Name (Legal Business Name): DUANE E PAQUETTE IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR NAVAL MEDICAL CENTER PORTSMOUTH, FAMILY PRACTICE
PORTSMOUTH VA
23708-2197
US

IV. Provider business mailing address

304 KING CT
SUFFOLK VA
23434-9116
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-2424
  • Fax:
Mailing address:
  • Phone: 661-865-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: