Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | 5101019091 | MI |
Y | 207RG0100X | Gastroenterologist | OS12686 | FL |
NPI | 1043471014 |
---|---|
Provider Name | Dr. Carla Melyssa Duffoo |
First Address | Tampa, FL 33612-4745 |
Second Address | Tampa, FL 33612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2008 |
Last Update Date | 05/07/2018 |