MEDICARE: DR. FREDERICK J DUFFY JR. M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208200000X	Plastic Surgery Physician	K2452	TX
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	K2452	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	250010502	OTHER	TX	MEDICARE RAILROAD - INDIVIDUAL
2	DG1038	OTHER	TX	MEDICARE RAILROAD GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376546101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK J DUFFY JR. M.D.

Provider Business Mailing Address
First Line	:	12201 MERIT DR
Second Line	:	SUITE 440
City	:	DALLAS
State	:	TX
Zip	:	75251-2122
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

Provider Business Practice Location Address
First Line	:	12201 MERIT DR
Second Line	:	SUITE 440
City	:	DALLAS
State	:	TX
Zip	:	75251-2122
Country	:	US
Telephone Number	:	469-501-1466
Fax Number	:	469-501-1465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	08/12/2025

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Directions to “ DR. FREDERICK J DUFFY JR. M.D.” Practice Location

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