Douglas Duffy, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

407 Issued in OK

Practice address

520 N Monte Vista St Ste C
Ada, OK 74820-4674

Phone

(580) 272-0018

Fax

(580) 272-0657

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566777600000",
    "number": "1184707457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MCDOUGAL DR",
            "city": "HOLDENVILLE",
            "state": "OK",
            "postal_code": "748482822",
            "telephone_number": "580-272-0018",
            "fax_number": "580-272-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N MONTE VISTA ST STE C",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748204674",
            "telephone_number": "580-272-0018",
            "fax_number": "580-272-0657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFFY",
        "first_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2019-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601002737",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200194390A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dr Charles W Gurley OD PC
• Dr. James L Clark, DDS
• Judd Andrew Drake
• DRS. Troska, Morgan and Johnston
• Ensie Drumgo, M.S.
• Chiquita Denniece Duncan, LPC, LADC
• Akilah Talibah Dunn, APRN-CNP
• Sherri Eades
• Earmaster, Inc.
• East Central University

• Surgical Physician Assistant in Ada, OK
• Providers in Ada, OK by specialty
• Surgical Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.