Provider Demographics
NPI:1851526594
Name:GARY L. CUSHING, M.D., A MEDICAL CORP.
Entity Type:Organization
Organization Name:GARY L. CUSHING, M.D., A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-549-7843
Mailing Address - Street 1:1551 BISHOP ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4665
Mailing Address - Country:US
Mailing Address - Phone:805-549-7843
Mailing Address - Fax:805-549-9489
Practice Address - Street 1:1551 BISHOP ST STE 510
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4665
Practice Address - Country:US
Practice Address - Phone:805-549-7843
Practice Address - Fax:805-549-9489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA507AMedicare PIN