Provider Demographics
NPI:1154325900
Name:DUFF, DON RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:RYAN
Last Name:DUFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 DUTCHMANS LN STE 4A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4745
Mailing Address - Country:US
Mailing Address - Phone:502-365-2655
Mailing Address - Fax:502-365-2770
Practice Address - Street 1:3999 DUTCHMANS LN STE 4A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4745
Practice Address - Country:US
Practice Address - Phone:502-365-2655
Practice Address - Fax:502-365-2770
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25228207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000062786OtherANTHEM
IN200014920AMedicaid
KY1050701OtherPASSPORT
KY64252281Medicaid
KY000000062786OtherANTHEM
KY64252281Medicaid
KY0219911Medicare ID - Type Unspecified
KY110095380Medicare ID - Type UnspecifiedPALMETTO GBA