Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 19195 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | 19195 | WV |
NPI | 1306874839 |
---|---|
Provider Name | Cameron Dewayne Duffy |
First Address | Martinsburg, WV 25401-1783 |
Second Address | Martinsburg, WV 25404-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 27/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000954023 | BLUE CROSS/BLUE SHIELD (01) | WV |
0135178 00 | (05) | MD |
1801943000 | (05) | WV |
G81898 | (02) | |
P0216471 | RAILROAD MEDICARE (01) | WV |