=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225762313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MSDDO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2022
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12156 LILAC HEIGHTS CT
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-951-8087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12156 LILAC HEIGHTS CT
-----------------------------------------------------
City | VALLEY CENTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92082-3319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-951-8087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL S DUFFY SR.
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 858-951-8087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------