Healthcare Provider Details

I. General information

NPI: 1265699581
Provider Name (Legal Business Name): JOEL L. RUSH D.O, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 NE 47 STREET SUITE 102
FT LAUDERDALE FL
33308-7708
US

IV. Provider business mailing address

1960 NE 47 STREET SUITE 102
FT LAUDERDALE FL
33308-7708
US

V. Phone/Fax

Practice location:
  • Phone: 954-463-3200
  • Fax: 954-463-3292
Mailing address:
  • Phone: 954-463-3200
  • Fax: 954-463-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberOS5228
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS5228
License Number StateFL

VIII. Authorized Official

Name: DR. JOEL L RUSH
Title or Position: PRESIDENT
Credential: D.O.
Phone: 954-463-3200