MEDICARE: JEFFERY RUSH

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	207T00000X	Neurological Surgery Physician	G22624	CA

General Provider Information

NPI Number	:	1922540178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY RUSH

Provider Business Mailing Address
First Line	:	400 N PARK AVE
Second Line	:	10 B
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-8709
Country	:	US
Telephone Number	:	970-453-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N PARK AVE
Second Line	:	10 B
City	:	BRECKENRIDGE
State	:	CO
Zip	:	80424-8709
Country	:	US
Telephone Number	:	970-453-5631
Fax Number	:

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

Provider Enumeration Date	:	11/04/2016
Last Update Date	:	11/04/2016

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Directions to “ JEFFERY RUSH ” Practice Location

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