Provider Demographics
NPI:1386038651
Name:DUFF, JOEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
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 1:425 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2350
Mailing Address - Country:US
Mailing Address - Phone:601-833-5713
Mailing Address - Fax:601-748-7063
Practice Address - Street 1:425 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2350
Practice Address - Country:US
Practice Address - Phone:601-833-5713
Practice Address - Fax:601-748-7063
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1G0841208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS14935523OtherCAQH