Provider Demographics
NPI:1962408518
Name:CUSHMAN, PHILLIP WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WAYNE
Last Name:CUSHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5801 NW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3812
Mailing Address - Country:US
Mailing Address - Phone:352-316-3761
Mailing Address - Fax:352-377-0991
Practice Address - Street 1:5801 NW 83RD TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3812
Practice Address - Country:US
Practice Address - Phone:352-316-3761
Practice Address - Fax:352-377-0991
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00149892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD83949Medicare UPIN