Provider Demographics
NPI:1588636153
Name:O'DUFFY, J. DESMOND (MD)
Entity Type:Individual
Prefix:
First Name:J. DESMOND
Middle Name:
Last Name:O'DUFFY
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 1:943 S BENEVA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2476
Mailing Address - Country:US
Mailing Address - Phone:941-366-3062
Mailing Address - Fax:941-957-1686
Practice Address - Street 1:943 S BENEVA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2476
Practice Address - Country:US
Practice Address - Phone:941-366-3062
Practice Address - Fax:941-957-1686
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74655207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D81718Medicare UPIN
FLE2575ZMedicare PIN