Provider Demographics
NPI:1194036574
Name:RUST, KERMIT RUSSELL III (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:RUSSELL
Last Name:RUST
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9300 E 29TH ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2183
Mailing Address - Country:US
Mailing Address - Phone:316-260-6762
Mailing Address - Fax:
Practice Address - Street 1:9300 E 29TH ST N STE 206
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2183
Practice Address - Country:US
Practice Address - Phone:316-260-6762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125058810207R00000X
OK283472085R0202X
DCMD0430002085R0204X
KS04-387882085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology