MEDICARE: DUC P VO MD

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	207X00000X	Orthopaedic Surgery Physician	K4825	TX
2	207XS0106X	Orthopaedic Hand Surgery Physician	K4825	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84594Y	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1063462547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUC P VO MD

Provider Business Mailing Address
First Line	:	2241 PEGGY LN
Second Line	:	SUITE A
City	:	GARLAND
State	:	TX
Zip	:	75042-5732
Country	:	US
Telephone Number	:	972-276-0536
Fax Number	:	972-276-6037

Provider Business Practice Location Address
First Line	:	2821 E PRESIDENT GEORGE BUSH HWY STE 306
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-4277
Country	:	US
Telephone Number	:	197-267-5950
Fax Number	:	972-675-9400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	09/08/2021

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Directions to “ DUC P VO MD” Practice Location

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