Provider Demographics
NPI:1205828753
Name:RUSTON L HESS
Entity Type:Organization
Organization Name:RUSTON L HESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSTON
Authorized Official - Middle Name:L
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-405-8791
Mailing Address - Street 1:3290 6TH AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5734
Mailing Address - Country:US
Mailing Address - Phone:386-405-8791
Mailing Address - Fax:
Practice Address - Street 1:2005 KNIGHT LANE BLDG H
Practice Address - Street 2:NAVY MEDICINE SUPPORT COMMAND, ATTN: MED STAFF SERVICES
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212-0140
Practice Address - Country:US
Practice Address - Phone:619-532-6684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257942100Medicaid
FLE3466AMedicare ID - Type Unspecified
U63009Medicare UPIN