Provider Demographics
NPI:1124679345
Name:MIDDLEBUSH, DAVID W
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:MIDDLEBUSH
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 1:250 BEESON AVE
Mailing Address - Street 2:
Mailing Address - City:SHEPHERD
Mailing Address - State:TX
Mailing Address - Zip Code:77371-6867
Mailing Address - Country:US
Mailing Address - Phone:832-880-4823
Mailing Address - Fax:
Practice Address - Street 1:250 BEESON AVE
Practice Address - Street 2:
Practice Address - City:SHEPHERD
Practice Address - State:TX
Practice Address - Zip Code:77371-6867
Practice Address - Country:US
Practice Address - Phone:832-880-4823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider