Provider Demographics
NPI:1831193408
Name:LUSK, DAVID P (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:LUSK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:900 N HERITAGE DR
Mailing Address - Street 2:BLDG A
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5536
Mailing Address - Country:US
Mailing Address - Phone:760-446-4571
Mailing Address - Fax:760-446-0970
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:BLDG A
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:760-446-4571
Practice Address - Fax:760-446-0970
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CAG57066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G570660OtherBLUE SHIELD
010032908OtherRAILROAD MEDICARE
93555B033OtherTRIWEST/TRICARE
00G570660OtherBLUE CROSS
CA00G570660Medicaid
00G570660OtherCOMMERCIAL INSURANCE
CA0103OtherJOHN DEERE
0616650001OtherDME
688278OtherAHI HEALTH LINK
688278OtherAHI HEALTH LINK
E35891Medicare UPIN
CA0103OtherJOHN DEERE