MEDICARE: DR. JENNIE ANN OZOG DUFFY MD

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	207N00000X	Dermatology Physician	F1516	TX

General Provider Information

NPI Number	:	1851395800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIE ANN OZOG DUFFY MD

Provider Business Mailing Address
First Line	:	6560 FANNIN ST STE 1720
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-790-0058
Fax Number	:	713-790-0410

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1720
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2735
Country	:	US
Telephone Number	:	713-790-0058
Fax Number	:	713-790-0410

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	06/14/2023

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