Provider Demographics
NPI:1902905458
Name:KUSHNER, NEIL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:DAVID
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 6TH ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1034
Mailing Address - Country:US
Mailing Address - Phone:707-442-8200
Mailing Address - Fax:707-442-8222
Practice Address - Street 1:519 6TH ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1034
Practice Address - Country:US
Practice Address - Phone:707-442-8200
Practice Address - Fax:707-442-8222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine