MEDICARE: MICHAEL JAMES RUSHTON DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	DP00321	OR
2	213ES0103X	Foot & Ankle Surgery Podiatrist	361600-0501	UT
3	332B00000X	Durable Medical Equipment & Medical Supplies	DP00321	OR

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	:	1659322998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JAMES RUSHTON DPM

Provider Business Mailing Address
First Line	:	2830 10TH ST
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1404
Country	:	US
Telephone Number	:	541-524-0122
Fax Number	:	541-524-2120

Provider Business Practice Location Address
First Line	:	2830 10TH ST
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1404
Country	:	US
Telephone Number	:	541-524-0122
Fax Number	:	541-524-2120

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	10/06/2014

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