Provider Demographics
NPI:1730147828
Name:DUFFIN, MARTHA ANN FEESS (DO)
Entity type:Individual
Prefix:
First Name:MARTHA ANN
Middle Name:FEESS
Last Name:DUFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 MARVEL LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2986
Mailing Address - Country:US
Mailing Address - Phone:816-792-1375
Mailing Address - Fax:
Practice Address - Street 1:501 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2732
Practice Address - Country:US
Practice Address - Phone:816-413-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100209208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2697572Medicare ID - Type Unspecified
F98872Medicare UPIN