Healthcare Provider Details

I. General information

NPI: 1932149010
Provider Name (Legal Business Name): JAMES GORDON CUSHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

PO BOX 1867
EL GRANADA CA
94018-1867
US

V. Phone/Fax

Practice location:
  • Phone: 410-428-8645
  • Fax:
Mailing address:
  • Phone: 410-428-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD61862
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number13793-320
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberD61862
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: