Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | WI50768 | WI |
NPI | 1033144977 |
---|---|
Provider Name | Dr. Merle S Rust |
First Address | Janesville, WI 53548-2940 |
Second Address | Janesville, WI 53548-2940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 29/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76944 | (02) |