Healthcare Provider Details

I. General information

NPI: 1720070758
Provider Name (Legal Business Name): DOWSE D. RUSTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 SCHWEERS LN
MT PLEASANT SC
29464-5086
US

IV. Provider business mailing address

376 SCHWEERS LN
MOUNT PLEASANT SC
29464-5086
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-9456
  • Fax: 843-849-0421
Mailing address:
  • Phone: 843-723-9456
  • Fax: 843-849-0421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5233
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: