MEDICARE: DR. JOHN DAVID CULBERTSON M.D.

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	207R00000X	Internal Medicine Physician	23216	AL
2	207R00000X	Internal Medicine Physician	26725	SC
3	207R00000X	Internal Medicine Physician	A99250	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7326490	OTHER	SC	CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7777585	OTHER	SC	AETNA
4	57-6007863095	OTHER	SC	BCBS OF SC
5	57-6007863095	OTHER	SC	BLUE CHOICE OF SC

General Provider Information

NPI Number	:	1649219833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID CULBERTSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6671
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95406-0671
Country	:	US
Telephone Number	:	707-544-7331
Fax Number	:

Provider Business Practice Location Address
First Line	:	895 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1916
Country	:	US
Telephone Number	:	415-925-3617
Fax Number	:	415-925-3597

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	01/22/2025

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Directions to “ DR. JOHN DAVID CULBERTSON M.D.” Practice Location

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