Provider Demographics
NPI:1255497251
Name:DUFFY, JOHN GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:DUFFY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 N. TUSTIN AVENUE, SUITE 130
Mailing Address - Street 2:SUITE 165
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-542-3008
Mailing Address - Fax:714-542-3617
Practice Address - Street 1:1401 N. TUSTIN AVENUE, SUITE 130
Practice Address - Street 2:SUITE 165
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-542-3008
Practice Address - Fax:714-542-3617
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA549482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA54948OtherMEDICAL LICENSE
CAG18383Medicare UPIN
CAWA54948CMedicare ID - Type Unspecified