Provider Demographics
NPI:1174610885
Name:MORAN, DAVID DUFFY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUFFY
Last Name:MORAN
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 1:42 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4054
Mailing Address - Country:US
Mailing Address - Phone:847-823-2129
Mailing Address - Fax:847-823-1639
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4054
Practice Address - Country:US
Practice Address - Phone:847-823-2129
Practice Address - Fax:847-823-1639
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-038570207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL457560OtherMEDICARE PTAN
0694000001OtherMEDICARE DME MAC
0694000001OtherMEDICARE DME MAC
IL457560OtherMEDICARE PTAN