Provider Demographics
NPI:1306871082
Name:MCBRIDE, DAVID LEROY (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEROY
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 TEJAS PL
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9123
Mailing Address - Country:US
Mailing Address - Phone:805-929-3211
Mailing Address - Fax:805-929-6440
Practice Address - Street 1:2515 MAIN ST
Practice Address - Street 2:STE. B & C
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3407
Practice Address - Country:US
Practice Address - Phone:805-927-5292
Practice Address - Fax:805-927-0354
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71032FMedicaid
CAW1508Medicare PIN
CAWA55266BMedicare PIN
CAPTAN DG032ZMedicare PIN
CA551977Medicare Oscar/Certification
CAA52912Medicare UPIN