Provider Demographics
NPI:1912103284
Name:CHISHOLM, DUGALD III (MD)
Entity Type:Individual
Prefix:
First Name:DUGALD
Middle Name:
Last Name:CHISHOLM
Suffix:III
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 1:105 S MAIN ST
Mailing Address - Street 2:STE 4
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9601
Mailing Address - Country:US
Mailing Address - Phone:805-434-1869
Mailing Address - Fax:
Practice Address - Street 1:105 S MAIN ST
Practice Address - Street 2:STE 4
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9601
Practice Address - Country:US
Practice Address - Phone:805-434-1869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110029207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine