Provider Demographics
NPI:1518935881
Name:RUSH, LESLIE VAUGHAN III (DO)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:VAUGHAN
Last Name:RUSH
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 SPRING HILL AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:341 GREENO RD N
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2979
Practice Address - Country:US
Practice Address - Phone:251-928-2401
Practice Address - Fax:251-928-5099
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.562208100000X
ALPM.12412081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL285140Medicaid
AL251264Medicaid
250000054Medicare ID - Type Unspecified