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1578742615
ROGER DAVID CUSHMAN
POCATELLO, ID
NPI
1578742615
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363AM0700X Physician Assistant Medical
(Licence: ID GPA-034)
Enumeration Date
2007-10-25
Last Update Date
2007-10-25
Business Address
ROGER DAVID CUSHMAN P.A.
2302 E. TERRY STREET
POCATELLO, ID 83201
Phone number: 208-235-5910
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Mailing Address
ROGER DAVID CUSHMAN P.A.
PO BOX 335
POCATELLO, ID 83204-0335
Phone number: 208-235-5910
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