Provider Demographics
NPI:1457673162
Name:RAYMOND S. DUFFETT, MD INC
Entity Type:Organization
Organization Name:RAYMOND S. DUFFETT, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CORBETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-747-2700
Mailing Address - Street 1:1335 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1135
Mailing Address - Country:US
Mailing Address - Phone:330-747-2700
Mailing Address - Fax:330-747-2211
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1135
Practice Address - Country:US
Practice Address - Phone:330-747-2700
Practice Address - Fax:330-747-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703082Medicaid
OH0703082Medicaid
OHA17338Medicare UPIN