Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 23239 | CA |
NPI | 1013077403 |
---|---|
Provider Name | Dr. Ranolph Duane Rush |
First Address | Santa Rosa, CA 95403-3634 |
Second Address | Santa Rosa, CA 95403-3634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |