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 1:7629 MARKET ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6075
Mailing Address - Country:US
Mailing Address - Phone:330-965-4541
Mailing Address - Fax:330-965-4559
Practice Address - Street 1:1335 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1185
Practice Address - Country:US
Practice Address - Phone:330-747-2700
Practice Address - Fax:330-747-2211
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703082Medicaid
OH0703082Medicaid
OH0703082Medicaid