Healthcare Provider Details

I. General information

NPI: 1184090946
Provider Name (Legal Business Name): BENJAMIN LEE DUFFY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N DUNLAP ST G10
MEMPHIS TN
38105-4625
US

IV. Provider business mailing address

850 POPLAR AVE. BUILDING 2
MEMPHIS TN
38103
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-4400
  • Fax: 901-287-5047
Mailing address:
  • Phone: 901-287-5928
  • Fax: 901-266-6455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54556
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: