Provider Demographics
NPI:1538193644
Name:DUNCAN, JAY M (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:M
Last Name:DUNCAN
Suffix:
Gender:M
Credentials:MD
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:801 7TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2733
Practice Address - Country:US
Practice Address - Phone:682-885-4268
Practice Address - Fax:682-885-7956
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM40452080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137345810OtherCSHCN GROUP NUMBER
TX140442852OtherMEDICAID GROUP NUMBER
TX183728804OtherCSHCN
TX00U87ZOtherMEDICARE GROUP NUMBER
TX183728803Medicaid
TXH77482Medicare UPIN
TX183728803Medicaid
TX8G9072Medicare PIN