MEDICARE: JOHN RUSTON ASFAR PA

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	363A00000X	Physician Assistant	PA09962	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8392NU	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629459623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN RUSTON ASFAR PA

Provider Business Mailing Address
First Line	:	3025 N TARRANT PKWY STE 220
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8629
Country	:	US
Telephone Number	:	817-697-3900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 N TARRANT PKWY STE 220
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-8629
Country	:	US
Telephone Number	:	817-885-7827
Fax Number	:

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

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	04/23/2019

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Directions to “ JOHN RUSTON ASFAR PA” Practice Location

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