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Individual

MICHAEL J MCCUSKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P. A.-C

Contact information

Practice address
530 NW 27TH ST, CORVALLIS, OR 97330-5223
(541) 766-6611
(541) 766-6186
Mailing address
981 NW SPRUCE AVE, CORVALLIS, OR 97330-2111
(541) 758-0766
(541) 753-2737

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MA052623
PA
363AM0700X
Medical Physician Assistant
Primary
PA01335
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500634427
OR
01
PA01335
OREGON MEDICAL BOARD
OR
Enumeration date
11/03/2006
Last updated
03/07/2023
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