Provider Demographics
NPI:1336135326
Name:RUSH-PEET, REBECCA BROWN (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:BROWN
Last Name:RUSH-PEET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BROWN
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24080 SE KENT KANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6801
Mailing Address - Country:US
Mailing Address - Phone:253-372-7680
Mailing Address - Fax:
Practice Address - Street 1:24080 SE KENT KANGLEY RD
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6801
Practice Address - Country:US
Practice Address - Phone:253-372-7680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00024168OtherSTATE LICENSE
WA8141020Medicaid
WA193753OtherLABOR & INDUSTRIES
BR3279115OtherDEA
8852929Medicare Oscar/Certification
WA8141020Medicaid