Provider Demographics
NPI:1518058171
Name:DUFFIN, WALTER JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:DUFFIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6751
Mailing Address - Country:US
Mailing Address - Phone:205-408-0027
Mailing Address - Fax:
Practice Address - Street 1:1071 KINGS WAY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6751
Practice Address - Country:US
Practice Address - Phone:205-408-0027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-3962085R0202X
ALDO.396208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-31560OtherBLUE SHIELD
ALDO.396OtherMEDICAL LICENSURE COMMISSION
AL510-31560OtherBLUE SHIELD