Provider Demographics
NPI:1356391908
Name:DUFFEK, CORY C (MD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:C
Last Name:DUFFEK
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 1:8791 CONFERENCE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-5822
Mailing Address - Country:US
Mailing Address - Phone:239-938-3500
Mailing Address - Fax:239-938-3555
Practice Address - Street 1:8791 CONFERENCE DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5822
Practice Address - Country:US
Practice Address - Phone:239-938-3500
Practice Address - Fax:239-938-3555
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13382085R0202X
FLME 1062162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL148Z2OtherBCBS FL
FL002436400Medicaid
FLP00899482OtherRR MEDICARE
FL148Z2OtherBCBS FL
FL002436400Medicaid