MARK T DUFFY (NPI# 1235167537) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235167537 |
| Entity Type | Individual |
| Full Name | MARK T DUFFY |
| Credential | MD |
| Practice Address |
2253 W Mason St Ste 100 Green Bay WI 54303-4706 |
| Mailing Address |
164 N Broadway Green Bay WI 54303-2728 |
| Practice Telephone | 9203277000 |
| Practice Fax Number | 9203277005 |
| Mailing Telephone | 9203277000 |
| Mailing Fax Number | 9203277005 |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2017-11-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | 47208 | WI | Allopathic & Osteopathic Physicians |
| Y | 207WX0200X |
Ophthalmology Specialization: Ophthalmic Plastic and Reconstructive Surgery |
47208 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 34564300 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194255513 | Mark Robert Duffy | Dentist | 2300 W Broad St, Columbus, OH 43204-3783 | 2017-06-18 |
| 1235676636 | Mark Duffy | Behavioral Analyst | 200 N Vineyard Blvd, Suite 153, Honolulu, HI 96817-3950 | 2017-01-23 |
| Street Address |
2253 W MASON ST STE 100 |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54303-4706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790720100 | Dianna L Bordewick | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-19 |
| 1497220107 | Linda Thieme | Technician/Technologist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2018-10-09 |
| 1306075635 | Jacob A Kozisek | Optometrist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2009-07-08 |
| 1265623649 | Joseph Thomas Bergmann | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2007-08-09 |
| 1932218005 | Wei-chuan Wang | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-08-30 |
| 1003828740 | Brad J Lavallie | Optometrist | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-08-12 |
| 1144241852 | Kevin P Wienkers | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-21 |
| 1558381632 | Brian T Perkovich | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-20 |
| 1790702652 | Kirk D Scattergood | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-07-16 |
| 1568490829 | William J Foster | Ophthalmology | 2253 W Mason St Ste 100, Green Bay, WI 54303-4706 | 2006-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952921033 | Ashley Marie Vandermoss | Social Worker | 1601 W Mason Street, Green Bay, WI 54303 | 2020-04-20 |
| 1598307423 | Jean Marie Castaneda | Case Manager/Care Coordinator | 2517 N. Court, Green Bay, WI 54303 | 2019-10-11 |
| 1215579552 | Integrated Treatment Centers, LLC | Clinic/Center | 2311 W Mason Street, Green Bay, WI 54303 | 2019-10-08 |
| 1003460551 | Affordable Dentures & Implants - Green Bay, S.c. | Dentist | 1800-c W. Mason Street, Green Bay, WI 54303 | 2019-08-01 |
| 1164940375 | Kaeley Rae Blaney | Student in an Organized Health Care Education/Training Program | 2088 Memorial Drive #208, Green Bay, WI 54303 | 2017-09-07 |
| 1518498047 | Treatment Providers LLC | Clinic/Center | 2731 N Packerland Dr Ste A, Green Bay, WI 54303 | 2017-03-26 |
| 1851840565 | Back To Balance Chiropractic, LLC | Chiropractor | 110 Packerland Drive, Suite B, Green Bay, WI 54303 | 2016-09-23 |
| 1710361001 | Matthew Lemay | Acupuncturist | 727 E Walnut, Suite B2, Green Bay, WI 54303 | 2015-07-16 |
| 1144600149 | Carrie Jean Banaszak | Counselor | 1039 Mason Street, Green Bay, WI 54303 | 2015-06-04 |
| 1174921993 | Kensey Meyer | Occupational Therapy Assistant | 1555 Dousman Road, Seymour, WI 54303 | 2014-12-10 |
| Find all providers in zip 54303 | ||||
| Taxonomy Code | 207WX0200X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| Specialization | Ophthalmic Plastic and Reconstructive Surgery |
| A physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck. |
| Notes: Source: American Academy of Ophthalmology, 2015. www.aao.org [1/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598828410 | Bruce Michael Massaro | Ophthalmology | 2600 N Mayfair Rd, Milwaukee, WI 53226-1309 | 2006-12-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.