Provider Demographics
NPI:1114436219
Name:RUSHFORTH, TYLER JAMES
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:RUSHFORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 AUSTIN DR NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-2055
Mailing Address - Country:US
Mailing Address - Phone:801-660-9367
Mailing Address - Fax:
Practice Address - Street 1:1935 ALABAMA HIGHWAY 157
Practice Address - Street 2:SUITE C
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1862
Practice Address - Country:US
Practice Address - Phone:256-297-3030
Practice Address - Fax:256-297-3301
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.2598207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine