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General NPI Number Information
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NPI Number | 1841627478
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Entity Type | Organization
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Legal Business Name | DUQUE PLLC
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 09/27/2013
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Provider Practice Location Address
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Address Line | 165 W 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3604
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Country | US
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Telephone | 405-513-5894
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Fax |
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Provider Business Mailing Address
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Address Line | 165 W 15TH ST
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City | EDMOND
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State | OK
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Zip | 73013-3604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERMILO S DUQUE
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Credential | DC
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Telephone | 405-513-5894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 4033
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License Number State | OK
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