Basic Information
| Provider Information | |||||||||
| NPI: | 1154325900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUFF | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3999 DUTCHMANS LN STE 4A | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023652655 | ||||||||
| FaxNumber: | 5023652770 | ||||||||
| Practice Location | |||||||||
| Address1: | 3999 DUTCHMANS LN STE 4A | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023652655 | ||||||||
| FaxNumber: | 5023652770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25228 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 25228 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 000000062786 | 01 | KY | ANTHEM | OTHER | 200014920A | 05 | IN | MEDICAID | 1050701 | 01 | KY | PASSPORT | OTHER | 64252281 | 05 | KY | MEDICAID |