Individual
DAVID K. CUSTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
112 7TH AVE, WALL, SD 57790-0423
(605) 279-2149
(605) 279-2139
Mailing address
353 FAIRMONT BLVD, ATTEN CHRISTIE MSS, RAPID CITY, SD 57701-7350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0123
SD
Other
Enumeration date
04/10/2006
Last updated
03/27/2014
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