Provider Demographics
NPI:1407343510
Name:DUKE, JOSEPH REED
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:REED
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 1:5156 W OLIVE AVE PMB 235
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4205
Mailing Address - Country:US
Mailing Address - Phone:502-541-7955
Mailing Address - Fax:
Practice Address - Street 1:5156 W OLIVE AVE PMB 235
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4205
Practice Address - Country:US
Practice Address - Phone:502-541-7955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7497363A00000X, 363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E3044324OtherNREMT
1153242OtherTHE NATIONAL COMMISSION OF CERTIFICATION OF PHYSICIAN ASSISTANTS