Provider Demographics
NPI:1093985137
Name:JOHN GREGORY DUFFY MD, APC
Entity Type:Organization
Organization Name:JOHN GREGORY DUFFY MD, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:714-669-3198
Mailing Address - Street 1:17821 E 17ST
Mailing Address - Street 2:SUITE 165
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2136
Mailing Address - Country:US
Mailing Address - Phone:714-669-3158
Mailing Address - Fax:714-669-3198
Practice Address - Street 1:17821 E 17ST
Practice Address - Street 2:SUITE 165
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2136
Practice Address - Country:US
Practice Address - Phone:714-669-3158
Practice Address - Fax:714-669-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0549482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18168Medicare PIN