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General NPI Number Information
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NPI Number | 1477690956
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Entity Type | Individual
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Provider Name | PETER ALLEN RUST PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 3360 COUNTY ROAD 220
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City | MIDDLEBURG
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State | FL
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Zip | 32068
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Country | US
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Telephone | 904-291-2221
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Fax | 904-291-2261
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Provider Business Mailing Address
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Address Line | 2503 ELBOW RD
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City | ORANGE PARK
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State | FL
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Zip | 32073-5504
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Country | US
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Telephone | 904-504-6773
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Fax | 904-291-2261
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9102776
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License Number State | FL
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