ROGER DAVID CUSHMAN

POCATELLO, ID
NPI1578742615
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: ID  GPA-034)
Enumeration Date2007-10-25
Last Update Date2007-10-25
Business Address
-- ROGER DAVID CUSHMAN P.A.
2302 E. TERRY STREET
POCATELLO, ID 83201
Phone number: 208-235-5910
Mailing Address
-- ROGER DAVID CUSHMAN P.A.
PO BOX 335
POCATELLO, ID 83204-0335
Phone number: 208-235-5910
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