Basic Information
| Provider Information | |||||||||
| NPI: | 1952410862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUFF | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HENDRICKS | ||||||||
| OtherFirstName: | MARY | ||||||||
| OtherMiddleName: | T | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 E PRIMROSE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172697900 | ||||||||
| FaxNumber: | 4172697990 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E PRIMROSE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172697900 | ||||||||
| FaxNumber: | 4172697990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/03/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 04-29559 | KS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 432500 | 01 | FIRSTGUARD | OTHER | 31357012 | 01 | MO | BCBS KANSAS CITY | OTHER | 100419950A | 05 | KS | MEDICAID | 205842107 | 05 | MO | MEDICAID | 160056822 | 01 | RR MEDICARE | OTHER |