Provider Demographics
NPI:1952410862
Name:DUFF, MARY H (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:H
Last Name:DUFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E PRIMROSE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5154
Mailing Address - Country:US
Mailing Address - Phone:417-269-7900
Mailing Address - Fax:417-269-7990
Practice Address - Street 1:1000 E PRIMROSE ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5154
Practice Address - Country:US
Practice Address - Phone:417-269-7900
Practice Address - Fax:417-269-7990
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29559207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
432500OtherFIRSTGUARD
MO31357012OtherBCBS KANSAS CITY
KS100419950AMedicaid
MO205842107Medicaid
160056822OtherRR MEDICARE
MO31357012OtherBCBS KANSAS CITY
H60181Medicare UPIN