Provider Demographics
NPI:1366898306
Name:MASHUSHIRE, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MASHUSHIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 JACOBSON DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8200
Mailing Address - Country:US
Mailing Address - Phone:469-235-7900
Mailing Address - Fax:
Practice Address - Street 1:2528 JACOBSON DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8200
Practice Address - Country:US
Practice Address - Phone:469-235-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver