Individual
JAMES R CUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1230 E MAIN STREET, MANKATO CLINIC AT MAIN STREET, MANKATO, MN 56002-8674
(507) 625-1811
Mailing address
PO BOX 8674, 1230 E. MAIN STREET, MANKATO, MN 56002-8674
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
18142
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115336
UCARE
MN
01
—
1600689
MEDICA
MN
05
—
232272200
—
MN
01
—
300049064
RR MEDICARE
—
01
—
3M374CU
BCBS
MN
01
—
410849339 56001 C025
CHAMPUS
—
01
—
764330
AMERICAS PPO
MN
01
—
90910
BCBS
IA
01
—
928747
MEDICAID
IA
01
—
HP24199
HEALTH PARTNERS
MN
01
—
NA2951014708
PREFERRED ONE
MN
Enumeration date
01/10/2006
Last updated
08/15/2011
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