Provider Demographics
NPI:1639145725
Name:RUST, STACE S (MD)
Entity Type:Individual
Prefix:DR
First Name:STACE
Middle Name:S
Last Name:RUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E SONTERRA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4349
Mailing Address - Country:US
Mailing Address - Phone:210-874-3359
Mailing Address - Fax:210-874-3369
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 1616
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-224-2655
Practice Address - Fax:866-644-0889
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5890207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX175939102Medicaid
TXI40489Medicare UPIN
TX8D9202Medicare ID - Type Unspecified
TX175939102Medicaid
TX8D9202Medicare PIN