Provider Demographics
NPI:1710061304
Name:LUSH, DAVID MH (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MH
Last Name:LUSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2690 NE KRESKY AVE
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-2412
Mailing Address - Country:US
Mailing Address - Phone:360-330-9595
Mailing Address - Fax:360-330-9560
Practice Address - Street 1:300 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:RAYMOND
Practice Address - State:WA
Practice Address - Zip Code:98577-3016
Practice Address - Country:US
Practice Address - Phone:360-942-3040
Practice Address - Fax:360-942-3955
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2015-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00000626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7840408Medicaid
WA7086519Medicaid
WAG8889107OtherMEDICARE
WAG8889107OtherMEDICARE
WA7840408Medicaid