Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 4764917-0501 | UT |
NPI | 1013007632 |
---|---|
Provider Name | Dr. Ryan Taylor Rushton |
First Address | Salt Lake City, UT 84151-0708 |
Second Address | Midvale, UT 84047-2013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480030542 | RAILROAD MEDICARE PIN (01) |