Provider Demographics
NPI:1407826571
Name:CUSHARD, WILLIAM GREEN JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GREEN
Last Name:CUSHARD
Suffix:JR
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 1:77 SCRIPPS DR
Mailing Address - Street 2:#200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6209
Mailing Address - Country:US
Mailing Address - Phone:916-929-3381
Mailing Address - Fax:916-641-2262
Practice Address - Street 1:77 SCRIPPS DR
Practice Address - Street 2:#200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6209
Practice Address - Country:US
Practice Address - Phone:916-929-3381
Practice Address - Fax:916-641-2262
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG19477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G194770Medicaid
CA460003612OtherRAILROAD MEDICARE
A40093Medicare UPIN
CA00G194770Medicare PIN