Healthcare Provider Details

I. General information

NPI: 1346220704
Provider Name (Legal Business Name): DYKES TAYLOR RUSHING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STUDENT HEALTH, APPALACHIAN STATE UNIVERSITY 614 HOWARD STREET, BOX 32070
BOONE NC
28608-0001
US

IV. Provider business mailing address

260 CHERRY DR
BOONE NC
28607-3717
US

V. Phone/Fax

Practice location:
  • Phone: 828-262-3100
  • Fax: 828-262-6262
Mailing address:
  • Phone: 828-262-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9700738
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: