MEDICARE: MR. DONALD B DUFFORD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY13444	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PSY13444	OTHER	CA	CA STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013922400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD B DUFFORD PHD

Provider Business Mailing Address
First Line	:	3668 STANCE AVE
Second Line	:
City	:	SOQUEL
State	:	CA
Zip	:	95073-2768
Country	:	US
Telephone Number	:	831-479-1960
Fax Number	:	408-377-7833

Provider Business Practice Location Address
First Line	:	3880 S BASCOM AVE
Second Line	:	SUITE 212
City	:	SAN JOSE
State	:	CA
Zip	:	95124-2674
Country	:	US
Telephone Number	:	408-559-9088
Fax Number	:	408-377-7833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	06/14/2026

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