MEDICARE: KEVIN R DUKE, DO, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	290545-1204	UT

General Provider Information

NPI Number	:	1003001959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN R DUKE, DO, PC

Provider Business Mailing Address
First Line	:	PO BOX 609
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-0609
Country	:	US
Telephone Number	:	435-752-0330
Fax Number	:	435-755-0922

Provider Business Practice Location Address
First Line	:	382 W 280 N
Second Line	:
City	:	PROVIDENCE
State	:	UT
Zip	:	84332-0609
Country	:	US
Telephone Number	:	435-752-0330
Fax Number	:	435-755-0922

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN R DUKE
Credential	:	D.O.
Telephone Number	:	435-752-0330

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	12/02/2011

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