Provider Demographics
NPI:1811059611
Name:MCDUFFIE, LISA (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 LONG DR STE A
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3282
Mailing Address - Country:US
Mailing Address - Phone:307-673-0126
Mailing Address - Fax:307-675-1208
Practice Address - Street 1:315 CAMINO DEL REMEDIO
Practice Address - Street 2:#258
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110
Practice Address - Country:US
Practice Address - Phone:805-681-5450
Practice Address - Fax:805-681-4747
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA748432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA74843AMedicare ID - Type UnspecifiedMEDICARE--SBCO.ADMHS