Individual
AUSTIN R CUSHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 N CURTIS RD STE 103, BOISE, ID 83706-1339
(208) 367-2670
(208) 367-2673
Mailing address
901 N CURTIS RD STE 103, BOISE, ID 83706-1339
(208) 367-2670
(208) 367-2673
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M4521
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010003661
BLUE SHIELD OF IDAHO
ID
01
—
4521-1
BLUE CROSS OF IDAHO
ID
Enumeration date
01/12/2007
Last updated
07/08/2007
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