Individual
JASON LEE DUKES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
221 NE GLEN OAK AVE, EMERGENCY DEPT, PEORIA, IL 61636-0002
(309) 672-5522
Mailing address
DEPT 960347, OKLAHOMA CITY, OK 73196-0001
(800) 684-0062
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004103
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00988299
RRMCARE THRU CES
IL
Enumeration date
08/30/2011
Last updated
02/07/2012
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