# DR. JOHN DUFFY DEWALT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1508869702
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 34002686D | OH | Yes |

## Other

- **Enumeration date:** 05/23/2005
- **Last updated:** 01/13/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0365073 | — | OH |
| 01 | — | 1269034 | BWC PROVIDER NUMBER | OH |
| 01 | — | CD3781 | MEDICARE RAILROAD | OH |