Provider Demographics
NPI:1871386649
Name:WITHERSPOON, DUANE JR
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:WITHERSPOON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-2812
Mailing Address - Country:US
Mailing Address - Phone:234-338-8364
Mailing Address - Fax:
Practice Address - Street 1:1118 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2812
Practice Address - Country:US
Practice Address - Phone:234-338-8364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health