Provider Demographics
NPI:1134141617
Name:RUST, JAMES W (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:RUST
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 LPGA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-7130
Mailing Address - Country:US
Mailing Address - Phone:386-274-3336
Mailing Address - Fax:386-274-3660
Practice Address - Street 1:1890 LPGA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-7130
Practice Address - Country:US
Practice Address - Phone:386-274-3336
Practice Address - Fax:386-274-3660
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1823213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054918500Medicaid
FL4380280001Medicare NSC
FLT54877Medicare UPIN
FL65025Medicare PIN