Provider Demographics
NPI:1477690956
Name:RUST, PETER ALLEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:ALLEN
Last Name:RUST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2503 ELBOW RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5504
Mailing Address - Country:US
Mailing Address - Phone:904-504-6773
Mailing Address - Fax:904-291-2261
Practice Address - Street 1:3360 COUNTY ROAD 220
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-291-2221
Practice Address - Fax:904-291-2261
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102776363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant