MEDICARE: DR. JEREMY KEITH RUSH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	P4376	TX
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	P4376	TX
3	207X00000X	Orthopaedic Surgery Physician	P4376	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477756625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY KEITH RUSH M.D.

Provider Business Mailing Address
First Line	:	4499 MEDICAL DR STE 235
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-692-1613
Fax Number	:	210-692-7557

Provider Business Practice Location Address
First Line	:	4499 MEDICAL DR STE 235
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3712
Country	:	US
Telephone Number	:	210-692-1613
Fax Number	:	210-692-7557

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	11/11/2025

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Directions to “ DR. JEREMY KEITH RUSH M.D.” Practice Location

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