Healthcare Provider Details

I. General information

NPI: 1003046020
Provider Name (Legal Business Name): ANDREW CRIGHTON RUTHERFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N GALLOWAY AVE
MESQUITE TX
75149-2433
US

IV. Provider business mailing address

9203 MILL HOLLOW DR
DALLAS TX
75243-6372
US

V. Phone/Fax

Practice location:
  • Phone: 214-320-7000
  • Fax:
Mailing address:
  • Phone: 214-727-8496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberN7483
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: