Provider Demographics
NPI:1376546101
Name:DUFFY, FREDERICK J JR (MD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:J
Last Name:DUFFY
Suffix:JR
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 1:12201 MERIT DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2122
Mailing Address - Country:US
Mailing Address - Phone:469-501-1466
Mailing Address - Fax:469-501-1465
Practice Address - Street 1:12201 MERIT DR
Practice Address - Street 2:SUITE 440
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2122
Practice Address - Country:US
Practice Address - Phone:469-501-1466
Practice Address - Fax:469-501-1465
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2452208200000X, 2082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX250010502OtherMEDICARE RAILROAD - INDIVIDUAL
TXDG1038OtherMEDICARE RAILROAD GROUP
TX120616104Medicaid
TX8F6142Medicare PIN
TX250010502OtherMEDICARE RAILROAD - INDIVIDUAL
TX120616104Medicaid