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General NPI Number Information
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NPI Number | 1437214202
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Entity Type | Individual
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Provider Name | ROBERT EDWARD RUST JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 10/17/2013
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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 | 208-290-3567
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Fax | 208-255-5531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M3004
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | M-3004
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License Number State | ID
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