Provider Demographics
NPI:1245285956
Name:DUFFY, ROBERT LAMAR (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAMAR
Last Name: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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3475
Mailing Address - Fax:251-434-3837
Practice Address - Street 1:1504 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-434-3475
Practice Address - Fax:251-434-3837
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05028325OtherUSA FAMILY MEDICINE
AL51528904OtherBC-USA FAMILY MEDICINE
AL009999075Medicaid
LA1063096Medicaid
LA1063096Medicaid
MS05028325OtherUSA FAMILY MEDICINE
ALC72190Medicare UPIN