Provider Demographics
NPI:1811198005
Name:CHUSTZ, PHILIP LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:LAMAR
Last Name:CHUSTZ
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 1:970 LAKELAND DR
Mailing Address - Street 2:SUITE 61
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4635
Mailing Address - Country:US
Mailing Address - Phone:601-982-7850
Mailing Address - Fax:601-366-8507
Practice Address - Street 1:970 LAKELAND DR
Practice Address - Street 2:SUITE 61
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4635
Practice Address - Country:US
Practice Address - Phone:601-982-7850
Practice Address - Fax:601-366-8507
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19505207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0365941OtherCIGNA
MSP00757825OtherRAILROAD MEDICARE
MS6029053OtherHEALTHSPRING
MS9911397OtherAETNA
MS05674733Medicaid
MS0365941OtherCIGNA