=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164253902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNCAN HEALTH DIRECT, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/13/2024
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 182 DOCK HOUSE RD
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-7384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-540-0490
-----------------------------------------------------
Fax | 904-679-5935
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 182 DOCK HOUSE RD
-----------------------------------------------------
City | SAINT JOHNS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32259-7384
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-540-0490
-----------------------------------------------------
Fax | 904-679-5935
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CORY HARTMAN DUNCAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-540-0490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------