Provider Demographics
NPI:1932184868
Name:DUFFIN, JOHN T (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:DUFFIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3384
Mailing Address - Country:US
Mailing Address - Phone:920-262-4800
Mailing Address - Fax:920-262-4813
Practice Address - Street 1:129 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3384
Practice Address - Country:US
Practice Address - Phone:920-262-4800
Practice Address - Fax:920-262-4813
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI871057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3909110Medicaid
WI3909110Medicaid
R60541Medicare UPIN