Healthcare Provider Details

I. General information

NPI: 1780622324
Provider Name (Legal Business Name): SAMUEL BURTON RUSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 MEDICAL CENTER DR E
CLOVIS CA
93611-6806
US

IV. Provider business mailing address

684 MEDICAL CENTER DR E
CLOVIS CA
93611-6806
US

V. Phone/Fax

Practice location:
  • Phone: 559-298-3850
  • Fax: 559-298-3830
Mailing address:
  • Phone: 559-298-3850
  • Fax: 559-298-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG17119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: