Provider Demographics
NPI:1043329717
Name:RUSCH, ROY RUSCH (MD)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:RUSCH
Last Name:RUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19695 SE WOODED HILLS DR
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97236-6313
Mailing Address - Country:US
Mailing Address - Phone:503-661-5628
Mailing Address - Fax:
Practice Address - Street 1:19695 SE WOODED HILLS DR
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97236-6313
Practice Address - Country:US
Practice Address - Phone:503-661-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12332207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery