Provider Demographics
NPI:1174382121
Name:DUNCAN, MALCOLM GARVEY SR (APRN)
Entity type:Individual
Prefix:
First Name:MALCOLM
Middle Name:GARVEY
Last Name:DUNCAN
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:MR
Other - First Name:MALCOLM
Other - Middle Name:GARVEY
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:836 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-1515
Mailing Address - Country:US
Mailing Address - Phone:121-492-6115
Mailing Address - Fax:
Practice Address - Street 1:824 N 99TH AVE STE 107108
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5324
Practice Address - Country:US
Practice Address - Phone:480-259-5746
Practice Address - Fax:623-775-2424
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127308363LP0808X
AZ1127308363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health