Healthcare Provider Details

I. General information

NPI: 1295710358
Provider Name (Legal Business Name): JOHN SPARROW DUFFY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 WEST MAIN STREET
CANTON NY
13617
US

IV. Provider business mailing address

39 WEST MAIN STREET
CANTON NY
13617
US

V. Phone/Fax

Practice location:
  • Phone: 315-379-4700
  • Fax: 315-713-6512
Mailing address:
  • Phone: 315-379-4700
  • Fax: 315-713-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number284577
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: