MEDICARE: MR. PATRICK MICHAEL DUFFEY DPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10143	OK
2	183500000X	Pharmacist	23970	TX
3	183500000X	Pharmacist	8784	AR

General Provider Information

NPI Number	:	1386642411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MICHAEL DUFFEY DPH

Provider Business Mailing Address
First Line	:	1532 N JANEWAY AVE
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-1621
Country	:	US
Telephone Number	:	405-794-9913
Fax Number	:	405-794-9913

Provider Business Practice Location Address
First Line	:	1000 N LEE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1036
Country	:	US
Telephone Number	:	405-272-6402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	02/07/2008

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