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General NPI Number Information
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NPI Number | 1417513532
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Entity Type | Organization
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Legal Business Name | ROBERT E. RUST MD
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 05/14/2019
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Provider Practice Location Address
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Address Line | 1301 N DIVISION AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-8268
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Country | US
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Telephone | 208-263-1345
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Fax | 208-255-5531
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Provider Business Mailing Address
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Address Line | 1301 N DIVISION AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-8268
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Country | US
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Telephone | 208-263-1345
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Fax | 208-255-5531
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Authorized Official
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Title or Position | PROVIDER
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Name | ROBERT E RUST
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Credential | MD, ABAM, FASAM
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Telephone | 208-290-3567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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