Provider Demographics
NPI:1568493773
Name:TUSHMAN, RICHARD SAUL DIAZ (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:SAUL DIAZ
Last Name:TUSHMAN
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 1:2410 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3512
Mailing Address - Country:US
Mailing Address - Phone:575-887-7281
Mailing Address - Fax:575-885-5983
Practice Address - Street 1:2410 W PIERCE ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3512
Practice Address - Country:US
Practice Address - Phone:575-887-7281
Practice Address - Fax:575-885-5983
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35967208800000X
NMMD2006-0523208800000X
LAMD.200955208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341525Medicaid
MS04653251Medicaid
LA1715611Medicaid
LA559375YH3UMedicare PIN
B06062Medicare UPIN
MS04653251Medicaid