MEDICARE: DR. DYKES TAYLOR RUSHING M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	9700738	NC

General Provider Information

NPI Number	:	1346220704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DYKES TAYLOR RUSHING M.D.

Provider Business Mailing Address
First Line	:	260 CHERRY DR
Second Line	:
City	:	BOONE
State	:	NC
Zip	:	28607-3717
Country	:	US
Telephone Number	:	828-262-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	STUDENT HEALTH, APPALACHIAN STATE UNIVERSITY
Second Line	:	614 HOWARD STREET, BOX 32070
City	:	BOONE
State	:	NC
Zip	:	28608-0001
Country	:	US
Telephone Number	:	828-262-3100
Fax Number	:	828-262-6262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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