Healthcare Provider Details

I. General information

NPI: 1346273471
Provider Name (Legal Business Name): WILLIAM S DUKART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MAPLEWOOD AVE
RONCEVERTE WV
24970-1334
US

IV. Provider business mailing address

200 MAPLEWOOD AVE
RONCEVERTE WV
24970-1334
US

V. Phone/Fax

Practice location:
  • Phone: 304-647-1146
  • Fax: 304-647-3006
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12936
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: