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Individual
DR. KENNETH D CUSHMAN
Active
Individual
DR. KENNETH D CUSHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E9483
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080078392
MEDICARE RAILROAD
TX
01
—
123043
CHIPS
TX
05
—
129526304
—
TX
01
—
4540308
AETNA
TX
01
—
752616977048
TRICARE CHAMPUS
TX
01
—
CU083Y750
BCBS
TX
Enumeration date
02/10/2006
Last updated
10/13/2014
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