Provider Demographics
NPI:1982083713
Name:CUSHING, BLAIR (DO)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:CUSHING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1548
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-1548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:505 E ROMIE LN STE F
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4031
Practice Address - Country:US
Practice Address - Phone:831-676-0210
Practice Address - Fax:831-256-2004
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9740207Q00000X
IL036.161757207Q00000X
NMDO2023-1016207Q00000X
NC2022-03356207Q00000X
CA20A15275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine