MEDICARE: MR. MARCO ANTONIO DUARTE M.D.

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	174400000X	Specialist
2	207V00000X	Obstetrics & Gynecology Physician	R4383	TX
3	207V00000X	Obstetrics & Gynecology Physician	80-141	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00471231	OTHER	NM	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639155765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCO ANTONIO DUARTE M.D.

Provider Business Mailing Address
First Line	:	4610 JEFFERSON LN NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-2117
Country	:	US
Telephone Number	:	505-559-4495
Fax Number	:	505-842-8025

Provider Business Practice Location Address
First Line	:	4532 N. MESA ST.
Second Line	:	3RD FLOOR STE 301
City	:	EL PASO
State	:	TX
Zip	:	79912-6286
Country	:	US
Telephone Number	:	915-317-5077
Fax Number	:	505-842-8025

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	03/02/2018

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Directions to “ MR. MARCO ANTONIO DUARTE M.D.” Practice Location

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