Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | DO14798 | OR |
NPI | 1366589905 |
---|---|
Provider Name | Mr. Bruce W Duffy |
First Address | Salem, OR 97306-9705 |
Second Address | Salem, OR 97306-9705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176727 | (05) | OR |
5004847 | HMO OREGON (01) | OR |
E38869 | (02) | OR |