Custis, John M
Custis, John M is an individual health care provider with primary practice located at 24900 Se Stark Ste 109, Gresham OR 97030. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Custis, John M can be contacted via phone (503) 667-1015.Contact Information
Primary practice address
24900 Se Stark Ste 109
Gresham OR 97030
Phone: (503) 667-1015
Fax: (503) 667-0406
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD09069 | Oregon |
Profile Details
| NPI number | 1770561813 |
|---|---|
| LBN Legal business name | Custis, John M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 9th, 2006 |
| Last updated | Dec 21st, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770561813 | NPPES |
| Oregon | MEDICAID | 276659 |
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