Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0423923 | KS |
Y | 208600000X | Surgeon | 0423923 | KS |
N | 208200000X | Surgeon | MD100181 | MO |
N | 208600000X | Surgeon | MD100181 | MO |
NPI | 1013027374 |
---|---|
Provider Name | Dr. J Douglas Cusick |
First Address | Leawood, KS 66211 |
Second Address | Leawood, KS 66211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100458460A | (05) | KS |
21177020 | BLUE SHIELD IND # (01) | MO |
F27195 | (02) |