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General NPI Number Information
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NPI Number | 1992708721
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Entity Type | Organization
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Legal Business Name | TEXAS CENTER FOR BREAST RECONSTRUCTION
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 12201 MERIT DR. SUITE 440
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City | DALLAS
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State | TX
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Zip | 75251-2122
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Country | US
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Telephone | 469-501-1466
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Fax | 469-501-1465
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Provider Business Mailing Address
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Address Line | 12201 MERIT DR. SUITE 440
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City | DALLAS
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State | TX
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Zip | 75251-2122
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Country | US
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Telephone | 469-501-1466
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Fax | 469-501-1465
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Authorized Official
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Title or Position | PRESIDENT
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Name | FREDERICK J. DUFFY JR.
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Credential | M.D.
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Telephone | 469-501-1466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | K2452
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2082S0099X
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Taxonomy Name | Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
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License Number | M1233
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | K2452
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License Number State | TX
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