Provider Demographics
NPI:1861553174
Name:DUARTE, JAIME ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ENRIQUE
Last Name:DUARTE
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 1:3003 NAVIGATION BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003-1239
Mailing Address - Country:US
Mailing Address - Phone:713-223-4466
Mailing Address - Fax:713-223-1571
Practice Address - Street 1:3003 NAVIGATION BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003-1239
Practice Address - Country:US
Practice Address - Phone:713-223-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163266301Medicaid
TX163266303Medicaid
TX8S0530OtherBLUE CROSS ID
TX7893532OtherAETNA ID
TXH72577Medicare UPIN
TX163266301Medicaid
TX00793HMedicare PIN