1861479354 NPI number — DR. BILLY LEE DUKE II MD

Table of content: (NPI 1952654873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861479354 NPI number — DR. BILLY LEE DUKE II MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUKE
Provider First Name:
BILLY
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
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:
1861479354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 WAYNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIALANTIC
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32903-3149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-615-1744
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 WAYNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIALANTIC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32903-3149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-615-1744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2005

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: 207VM0101X , with the licence number:  MD35803 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: ME102267 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1051926 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4071531 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3878282 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4071531 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5339029 . This is a "AETNA HMO/PPO" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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