Cusack, Barry Justin

Cusack, Barry Justin is an individual health care provider with primary practice located at 500 West Fort St (111), Boise ID 83702-4598. He recently has only one registered license in Allopathic & Osteopathic Physicians / Geriatric Medicine, which is considered as his primary health care specialty. Cusack, Barry Justin can be contacted via phone (208) 422-1000.

Contact Information

Primary practice address
500 West Fort St (111) Boise ID 83702-4598
Fax: (208) 422-1319
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X M5678 Idaho

Profile Details

NPI number 1720187289
LBN Legal business name Cusack, Barry Justin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720187289 NPPES
Idaho Other M5678 STATE MEDICAL LICENCE

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