Provider Demographics
NPI:1366472599
Name:CHISHOLM, DUGALD D (MD)
Entity Type:Individual
Prefix:DR
First Name:DUGALD
Middle Name:D
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 MORRO RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3924
Mailing Address - Country:US
Mailing Address - Phone:805-466-5626
Mailing Address - Fax:805-466-2322
Practice Address - Street 1:8575 MORRO RD
Practice Address - Street 2:SUITE K
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3924
Practice Address - Country:US
Practice Address - Phone:805-466-5626
Practice Address - Fax:805-466-2322
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22464174400000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry