MEDICARE: THOMAS C RUSHTON MD

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	207R00000X	Internal Medicine Physician	17822	WV
2	207RI0200X	Infectious Disease Physician	17822	WV
3	207RI0200X	Infectious Disease Physician	ME63732	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740245018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS C RUSHTON MD

Provider Business Mailing Address
First Line	:	PO BOX 45443
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84145-0443
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	820 PRUDENTIAL DR STE 515
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8207
Country	:	US
Telephone Number	:	904-396-4886
Fax Number	:	904-398-0496

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	12/30/2020

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Directions to “ THOMAS C RUSHTON MD” Practice Location

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