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General NPI Number Information
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NPI Number | 1093985137
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Entity Type | Organization
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Legal Business Name | JOHN GREGORY DUFFY MD, APC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 17821 E 17ST SUITE 165
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City | TUSTIN
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State | CA
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Zip | 92780-2136
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Country | US
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Telephone | 714-669-3158
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Fax | 714-669-3198
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Provider Business Mailing Address
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Address Line | 17821 E 17ST SUITE 165
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City | TUSTIN
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State | CA
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Zip | 92780-2136
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Country | US
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Telephone | 714-669-3158
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Fax | 714-669-3198
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN GREGORY DUFFY
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Credential | M.D,
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Telephone | 714-669-3198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A054948
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License Number State | CA
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