Provider Demographics
NPI:1447255740
Name:DUNCAN, LAEL CONWAY (MD)
Entity type:Individual
Prefix:DR
First Name:LAEL
Middle Name:CONWAY
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAEL
Other - Middle Name:CATHERINE
Other - Last Name:CONWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 LARKSPUR LANDING CIR
Mailing Address - Street 2:STE 10
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1836
Mailing Address - Country:US
Mailing Address - Phone:415-924-4660
Mailing Address - Fax:
Practice Address - Street 1:1125 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:415-456-9680
Practice Address - Fax:415-485-3507
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87317207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA129127OtherL & I
WA8021123OtherDSHS
WAF84045Medicare UPIN
WA129127OtherL & I