Provider Demographics
NPI:1649219833
Name:CULBERTSON, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:CULBERTSON
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:PO BOX 6671
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95406-0671
Mailing Address - Country:US
Mailing Address - Phone:707-544-7331
Mailing Address - Fax:
Practice Address - Street 1:895 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1916
Practice Address - Country:US
Practice Address - Phone:415-925-3617
Practice Address - Fax:415-925-3597
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23216207R00000X
SC26725207R00000X
CAA99250207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7326490OtherCIGNA
SC267259Medicaid
SC7777585OtherAETNA
SC57-6007863095OtherBCBS OF SC
SC57-6007863095OtherBLUE CHOICE OF SC
SCH511893640Medicare ID - Type UnspecifiedSC MEDICARE
SC7777585OtherAETNA