Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD 60320264 | WA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD 60320264 | WA |
NPI | 1770795262 |
---|---|
Provider Name | Cuchulain Luke Rust |
First Address | Vancouver, WA 98664-3299 |
Second Address | Vancouver, WA 98664-3299 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 11/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1770795262 | (05) | WA |