Provider Demographics
NPI:1720036874
Name:ZUSMAN, JAIME (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:ZUSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2533
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79105-2533
Mailing Address - Country:US
Mailing Address - Phone:806-212-5079
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1500 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1794
Practice Address - Country:US
Practice Address - Phone:806-359-4673
Practice Address - Fax:806-356-1901
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM22232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175630603Medicaid
TX292971YM5UMedicare UPIN
TX175630603Medicaid
OK200060470AMedicaid
NM7757212Medicaid
KS200355520AMedicaid
TX8K7194OtherBCBS
TX3179345OtherBCBS LINK NUMBER
TX145476100OtherFIRSTCARE & SW LIFE
KS200355520AMedicaid
TX8D8400Medicare ID - Type Unspecified