Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME38633 | FL |
NPI | 1306884119 |
---|---|
Provider Name | Charles W Rush |
First Address | Sarasota, FL 34232-6028 |
Second Address | Sarasota, FL 34232-6028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 20/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D32891 | (02) | FL |