Healthcare Provider Details

I. General information

NPI: 1003072406
Provider Name (Legal Business Name): PAUL DOUGLAS DUKARM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8730 STONY POINT PKWY
RICHMOND VA
23235
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-327-1166
  • Fax: 804-327-1170
Mailing address:
  • Phone: 804-358-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005977
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number0810005977
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: