Healthcare Provider Details

I. General information

NPI: 1568559888
Provider Name (Legal Business Name): CHRISTOPHER NEVILLE USSHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KENNARD ST
MAPLEWOOD MN
55109-5465
US

IV. Provider business mailing address

2261 DOUGLAS BLVD
ROSEVILLE CA
95661-3831
US

V. Phone/Fax

Practice location:
  • Phone: 650-737-2692
  • Fax:
Mailing address:
  • Phone: 831-423-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA52359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: