Provider Demographics
NPI:1396341764
Name:DUKE, DAVIN
Entity type:Individual
Prefix:
First Name:DAVIN
Middle Name:
Last Name:DUKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 HILTON PKWY STE 202D
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-3566
Mailing Address - Country:US
Mailing Address - Phone:719-432-9222
Mailing Address - Fax:719-960-2894
Practice Address - Street 1:4570 HILTON PKWY STE 202D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3566
Practice Address - Country:US
Practice Address - Phone:719-432-9222
Practice Address - Fax:719-960-2894
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO936956Medicaid