Provider Demographics
NPI:1255353520
Name:DUANE, PETER GILBERT (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:GILBERT
Last Name:DUANE
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 1:4400 FONDELL DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4152
Mailing Address - Country:US
Mailing Address - Phone:952-926-3888
Mailing Address - Fax:612-727-5659
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:MEDICINE SERVICE, 111
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-725-2085
Practice Address - Fax:612-727-5659
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN27840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine