Healthcare Provider Details

I. General information

NPI: 1780698951
Provider Name (Legal Business Name): ROBERT C RUSHFORD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOUTH PINE STREET
DERIDDER LA
70634-0730
US

IV. Provider business mailing address

600 SOUTH PINE STREET
DERIDDER LA
70634-0730
US

V. Phone/Fax

Practice location:
  • Phone: 337-462-7100
  • Fax:
Mailing address:
  • Phone: 337-462-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN082270
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: