Provider Demographics
NPI:1679542278
Name:DUKES, THOMAS H III (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:DUKES
Suffix:III
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 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-723-0202
Mailing Address - Fax:843-723-1052
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 460
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-723-0202
Practice Address - Fax:843-723-1052
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC087685Medicaid
SC087685Medicaid
SC3124Medicare PIN