Provider Demographics
NPI:1386612729
Name:DUQUETTE, GEORGE R (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:R
Last Name:DUQUETTE
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 SHADES CREST RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1414
Mailing Address - Country:US
Mailing Address - Phone:205-822-7009
Mailing Address - Fax:
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-877-2918
Practice Address - Fax:205-877-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10679OtherBC/BS PROVIDER #
C75668Medicare UPIN