Provider Demographics
NPI:1598032385
Name:RUSCIANO, JON J (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:J
Last Name:RUSCIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 BELLAIRE BLVD # 226
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3901
Mailing Address - Country:US
Mailing Address - Phone:832-380-5354
Mailing Address - Fax:
Practice Address - Street 1:4849 CALHOUN RD RM 2005
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-2043
Practice Address - Country:US
Practice Address - Phone:713-743-5151
Practice Address - Fax:832-842-5153
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP11372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333380901Medicaid
TX333380901Medicaid