Provider Demographics
NPI:1366440265
Name:RUSHFORD, FREDERICK E (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:E
Last Name:RUSHFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:21212 NORTHWEST FWY
Mailing Address - Street 2:SUITE 345
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-5884
Mailing Address - Country:US
Mailing Address - Phone:281-897-8827
Mailing Address - Fax:281-894-2829
Practice Address - Street 1:21212 NORTHWEST FWY
Practice Address - Street 2:SUITE 345
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5884
Practice Address - Country:US
Practice Address - Phone:281-897-8827
Practice Address - Fax:281-894-2829
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG1528207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00GF88OtherPTAN
TX033581201Medicaid
TX45D0492837OtherCLIA #
TX080010027OtherMEDICARE RR
TX45D0492837OtherCLIA #