Provider Demographics
NPI:1740270990
Name:DUFFETT, RAYMOND SCOTT (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:SCOTT
Last Name:DUFFETT
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-9657
Mailing Address - Fax:336-716-6286
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1185
Practice Address - Country:US
Practice Address - Phone:336-716-9657
Practice Address - Fax:336-716-6286
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7879207X00000X
NC2024-03085207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703082Medicaid
OH0703082Medicaid
OH0703082Medicaid