Provider Demographics
NPI:1285275438
Name:DUQUE, DAVID III (MAT, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:DUQUE
Suffix:III
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-0517
Mailing Address - Country:US
Mailing Address - Phone:361-406-7140
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 517
Practice Address - Street 2:
Practice Address - City:PREMONT
Practice Address - State:TX
Practice Address - Zip Code:78375-0517
Practice Address - Country:US
Practice Address - Phone:361-406-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program