Provider Demographics
NPI:1174573661
Name:DUQUETTE, EUGENE P (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:P
Last Name:DUQUETTE
Suffix:
Gender:M
Credentials:DO
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 50770
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-0770
Mailing Address - Country:US
Mailing Address - Phone:307-333-6910
Mailing Address - Fax:307-333-6912
Practice Address - Street 1:1233 E 2ND STREET
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4815
Practice Address - Country:US
Practice Address - Phone:307-333-6910
Practice Address - Fax:307-333-6912
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6391A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43499200Medicaid
WI930122965OtherMEDICARE RAILROAD
WI43499200Medicaid
WI930122965OtherMEDICARE RAILROAD