Provider Demographics
NPI:1417258914
Name:RUSH, BRIAN EDWARD (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:RUSH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1085
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-1085
Mailing Address - Country:US
Mailing Address - Phone:720-490-3249
Mailing Address - Fax:
Practice Address - Street 1:914 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-2116
Practice Address - Country:US
Practice Address - Phone:480-557-0241
Practice Address - Fax:303-666-5362
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant