Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME80485 | FL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME80485 | FL |
NPI | 1265422182 |
---|---|
Provider Name | Gavan Patrick Duffy |
First Address | Jacksonville, FL 32216-8070 |
Second Address | Jacksonville, FL 32256-5003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2005 |
Last Update Date | 26/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200038627 | RAILROAD MEDICARE (01) | FL |
268063700 | (05) | FL |
35366 | BLUECROSS/BLUESHIELD (01) | FL |
G45044 | (02) | FL |