Individual
WALTER H CUSHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4005 24TH ST, LUBBOCK, TX 79410-1835
(806) 792-2767
(888) 861-8858
Mailing address
4005 24TH ST, LUBBOCK, TX 79410-1831
(806) 792-2767
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
J9866
TX
2085R0204X
Vascular & Interventional Radiology Physician
J9866
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111137100
FIRSTCARE
TX
05
—
126616504
—
TX
01
—
300109579
RAILROAD MEDICARE
TX
01
—
87452Y
BLUECROSS
TX
05
—
Z0681
—
NM
Enumeration date
06/10/2005
Last updated
02/21/2022
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