Provider Demographics
NPI:1710914791
Name:DEFIGARD, MARY DONALDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DONALDSON
Last Name:DEFIGARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:15066 LOS GATOS ALMADEN RD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-377-9180
Mailing Address - Fax:408-377-1459
Practice Address - Street 1:15066 LOS GATOS ALMADEN RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-377-9180
Practice Address - Fax:408-377-1459
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG297128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG291280Medicaid
CAOOG291280Medicaid
A43957Medicare UPIN