Provider Demographics
NPI:1336534783
Name:MOGOLLON DUFFO, FRANCIS PAMELA (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:PAMELA
Last Name:MOGOLLON DUFFO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5601
Mailing Address - Fax:321-952-6179
Practice Address - Street 1:1130 HICKORY ST STE B
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1973
Practice Address - Country:US
Practice Address - Phone:321-361-5601
Practice Address - Fax:321-952-6179
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151527207RH0003X, 207RX0202X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111423700Medicaid
FLN7875OtherFL HF MEDICARE