Individual
DR. PHILIP LAMAR CHUSTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
970 LAKELAND DR, SUITE 61, JACKSON, MS 39216-4635
(601) 982-7850
(601) 366-8507
Mailing address
970 LAKELAND DR, SUITE 61, JACKSON, MS 39216-4635
(601) 982-7850
(601) 366-8507
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
19505
MS
207RC0000X
Cardiovascular Disease Physician
19505
MS
207RI0011X
Interventional Cardiology Physician
Primary
19505
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0365941
CIGNA
MS
05
—
05674733
—
MS
01
—
6029053
HEALTHSPRING
MS
01
—
9911397
AETNA
MS
01
—
P00757825
RAILROAD MEDICARE
MS
Enumeration date
05/29/2007
Last updated
12/04/2024
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