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General NPI Number Information
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NPI Number | 1144210857
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Entity Type | Individual
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Provider Name | BENJAMIN J DUFFY D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/25/2005
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 200 THEDA CLARK MEDICAL PLZ STE 420
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City | NEENAH
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State | WI
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Zip | 54956-2771
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Country | US
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Telephone | 920-720-7211
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Fax |
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-720-7211
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 48370-021
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 48370
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207RB0002X
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Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
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License Number | 48370-021
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License Number State | WI
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