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General NPI Number Information
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NPI Number | 1851526594
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Entity Type | Organization
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Legal Business Name | GARY L. CUSHING, M.D., A MEDICAL CORP.
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 1551 BISHOP ST STE 510
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4665
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Country | US
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Telephone | 805-549-7843
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Fax | 805-549-9489
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Provider Business Mailing Address
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Address Line | 1551 BISHOP ST STE 510
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-4665
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Country | US
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Telephone | 805-549-7843
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Fax | 805-549-9489
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY L CUSHING
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Credential | MD
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Telephone | 805-549-7843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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