MEDICARE: DUC M TU 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	207Q00000X	Family Medicine Physician	17179	OK

Other Identifiers

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

General Provider Information

NPI Number	:	1649201807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUC M TU MD

Provider Business Mailing Address
First Line	:	PO BOX 268986
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8986
Country	:	US
Telephone Number	:	405-231-3857
Fax Number	:	405-272-7977

Provider Business Practice Location Address
First Line	:	1111 N LEE AVE
Second Line	:	SUITE 235
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2600
Country	:	US
Telephone Number	:	405-272-6580
Fax Number	:	405-272-6590

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/21/2020

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Directions to “ DUC M TU MD” Practice Location

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