Individual
DR. JOHN DUFFY DEWALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
144 EAST MAIN STREET, LOGAN, OH 43138
(740) 385-1881
(740) 385-1875
Mailing address
144 E MAIN ST, LOGAN, OH 43138
(740) 385-1881
(740) 385-1875
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
34002686D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0365073
—
OH
01
—
1269034
BWC PROVIDER NUMBER
OH
01
—
CD3781
MEDICARE RAILROAD
OH
Enumeration date
05/23/2005
Last updated
01/13/2016
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