1063462547 NPI number — DUC P VO MD

Table of content: DUC P VO MD (NPI 1063462547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063462547 NPI number — DUC P VO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VO
Provider First Name:
DUC
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063462547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2821 E PRESIDENT GEORGE BUSH HWY STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75082-4277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
197-267-5950
Provider Business Practice Location Address Fax Number:
972-675-9400
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  K4825 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0106X , with the licence number: K4825 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84594Y . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".