Healthcare Provider Details

I. General information

NPI: 1770648123
Provider Name (Legal Business Name): DARIN S RUTHERFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 N WASHINGTON ST
JANESVILLE WI
53548-2907
US

IV. Provider business mailing address

557 N WASHINGTON ST
JANESVILLE WI
53548-2907
US

V. Phone/Fax

Practice location:
  • Phone: 608-754-6000
  • Fax:
Mailing address:
  • Phone: 608-754-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38108
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number38108
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: