Provider Demographics
NPI:1548654528
Name:DUFFIN, BRYAN MICHAEL (DPM)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:MICHAEL
Last Name:DUFFIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY STE 106
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3565
Mailing Address - Country:US
Mailing Address - Phone:214-217-3668
Mailing Address - Fax:214-217-3669
Practice Address - Street 1:3201 E PRESIDENT GEORGE BUSH HWY STE 106
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-3565
Practice Address - Country:US
Practice Address - Phone:214-217-3668
Practice Address - Fax:214-217-3669
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2382213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty