MEDICARE: DR. LAURA ELISA DUSSAN DUQUE 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	207V00000X	Obstetrics & Gynecology Physician	R82576	AZ

General Provider Information

NPI Number	:	1326976564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA ELISA DUSSAN DUQUE MD

Provider Business Mailing Address
First Line	:	10600 CHESTER AVE APT 1717
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-0219
Country	:	US
Telephone Number	:	786-762-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-0001
Country	:	US
Telephone Number	:	520-694-6010
Fax Number	:	520-626-1446

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

Provider Enumeration Date	:	05/09/2026
Last Update Date	:	05/09/2026

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