Healthcare Provider Details

I. General information

NPI: 1023058351
Provider Name (Legal Business Name): CHRISTOPHER T RUSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

121 HARBOR BLUFF DR
LARGO FL
33770-2655
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax: 317-705-5047
Mailing address:
  • Phone: 727-584-0909
  • Fax: 727-588-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57435
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME75780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: