Healthcare Provider Details

I. General information

NPI: 1720583206
Provider Name (Legal Business Name): JACK RUSING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 E HARVARD AVE STE 565
DENVER CO
80210-5028
US

IV. Provider business mailing address

850 E HARVARD AVE STE 565
DENVER CO
80210-5028
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-3333
  • Fax:
Mailing address:
  • Phone: 303-777-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR.0070279
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: