Provider Demographics
NPI:1174718837
Name:DUNCAN, HARELLE CASSY (MD)
Entity type:Individual
Prefix:DR
First Name:HARELLE
Middle Name:CASSY
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HARELLE
Other - Middle Name:CASSY
Other - Last Name:MENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:#300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5658
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4963
Practice Address - Fax:904-244-4799
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105010207R00000X
GA062882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146J2OtherBC/BC
FL002023100Medicaid
FL002023100Medicaid