Healthcare Provider Details

I. General information

NPI: 1417989724
Provider Name (Legal Business Name): JAY DANIEL DUHON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 OHIO DR STE. 130
PLANO TX
75093-3927
US

IV. Provider business mailing address

13435 MILL GROVE LN
DALLAS TX
75240-5535
US

V. Phone/Fax

Practice location:
  • Phone: 214-476-4137
  • Fax: 972-867-3402
Mailing address:
  • Phone: 214-476-4137
  • Fax: 972-867-3402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number23838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: