Healthcare Provider Details

I. General information

NPI: 1649219833
Provider Name (Legal Business Name): JOHN DAVID CULBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1916
US

IV. Provider business mailing address

PO BOX 6671
SANTA ROSA CA
95406-0671
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-3617
  • Fax: 415-925-3597
Mailing address:
  • Phone: 707-544-7331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23216
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26725
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA99250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: