MEDICARE: DR. PHILLIP WAYNE CUSHMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0014989	FL

General Provider Information

NPI Number	:	1962408518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP WAYNE CUSHMAN M.D.

Provider Business Mailing Address
First Line	:	5801 NW 83RD TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-3812
Country	:	US
Telephone Number	:	352-316-3761
Fax Number	:	352-377-0991

Provider Business Practice Location Address
First Line	:	5801 NW 83RD TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32653-3812
Country	:	US
Telephone Number	:	352-316-3761
Fax Number	:	352-377-0991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	03/15/2013

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