Provider Demographics
NPI:1437406212
Name:RUSTON, VERONICA J (DO)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:J
Last Name:RUSTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 N DYSART RD STE 202-152
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3032
Mailing Address - Country:US
Mailing Address - Phone:904-631-4939
Mailing Address - Fax:
Practice Address - Street 1:4494 W PEORIA AVE STE 115A
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-2020
Practice Address - Country:US
Practice Address - Phone:623-295-0787
Practice Address - Fax:313-241-9327
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7122207Q00000X
AZ007469208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine