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 1:7777 FOREST LN
Mailing Address - Street 2:STE C504
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6844
Mailing Address - Country:US
Mailing Address - Phone:972-566-3939
Mailing Address - Fax:972-566-3999
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:STE C504
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-3939
Practice Address - Fax:972-566-3999
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK24522082S0099X, 208200000X
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
TX120616104Medicaid
TXDG1038OtherMEDICARE RAILROAD GROUP
TX8F6142Medicare PIN
TX250010502OtherMEDICARE RAILROAD - INDIVIDUAL
TX120616104Medicaid