Provider Demographics
NPI:1407861578
Name:RUSK, NATALIE W (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:W
Last Name:RUSK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W 38TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6408
Mailing Address - Country:US
Mailing Address - Phone:512-467-7334
Mailing Address - Fax:512-467-7335
Practice Address - Street 1:1600 W 38TH ST STE 105
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6408
Practice Address - Country:US
Practice Address - Phone:512-467-7334
Practice Address - Fax:512-467-7335
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3722208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186481102Medicaid
TX186481101Medicaid
TX186481103Medicaid
TX186481104Medicaid
TX186481102Medicaid
TX8J3032Medicare PIN
TX8K1795Medicare PIN
TX186481103Medicaid