Provider Demographics
NPI:1033609136
Name:DUFFEY, RODERICK LAMAR
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:LAMAR
Last Name:DUFFEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NEW
Other - Middle Name:
Other - Last Name:PATH HOMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2123 BALLYCASTLE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4512
Mailing Address - Country:US
Mailing Address - Phone:682-597-6028
Mailing Address - Fax:
Practice Address - Street 1:2123 BALLYCASTLE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-4512
Practice Address - Country:US
Practice Address - Phone:682-597-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health