Healthcare Provider Details

I. General information

NPI: 1932248119
Provider Name (Legal Business Name): MEGAN MARY RUST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 FANNIN STREET MS205
HOUSTON TX
77030
US

IV. Provider business mailing address

PO BOX 4701
HOUSTON TX
77210-4701
US

V. Phone/Fax

Practice location:
  • Phone: 713-394-6450
  • Fax:
Mailing address:
  • Phone: 713-441-3885
  • Fax: 713-441-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberL5889
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number21812
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: