Provider Demographics
NPI:1437265683
Name:RAST, PHILIP RENTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:RENTZ
Last Name:RAST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1605 MULKEY RD
Mailing Address - Street 2:BLDG 2, SUITE 210
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1127
Mailing Address - Country:US
Mailing Address - Phone:770-739-2474
Mailing Address - Fax:770-944-6357
Practice Address - Street 1:1605 MULKEY RD
Practice Address - Street 2:BLDG 2, SUITE 210
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1127
Practice Address - Country:US
Practice Address - Phone:770-739-2474
Practice Address - Fax:770-944-6357
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA29366208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC48319Medicare UPIN
GA34BDFHBMedicare PIN