Rushton, Fred Wallace

Rushton, Fred Wallace is an sole proprietor health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Vascular Surgery, which is considered as his primary health care specialty. Rushton, Fred Wallace can be contacted via phone (601) 925-6805.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 925-6805
Fax: (601) 926-4978
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X 06237 Mississippi

Profile Details

NPI number 1194825323
LBN Legal business name Rushton, Fred Wallace
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 25th, 2006
Last updated Apr 22nd, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194825323 NPPES
Mississippi MEDICAID 0013429
Mississippi Other 020046786 GRPCG6446
Mississippi MEDICAID 158101
Mississippi Other P00462318

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