Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 6099540-1205 | UT |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 6099540-1205 | UT |
N | 207ND0900X | Dermatopathologist | 60995401205 | UT |
N | 207NS0135X | Procedural Dermatology | 60995401205 | UT |
NPI | 1770779050 |
---|---|
Provider Name | Dr. Keith Duffy |
First Address | Salt Lake City, UT 84110-3208 |
Second Address | Salt Lake City, UT 84112-1102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2007 |
Last Update Date | 05/11/2021 |