Provider Demographics
NPI:1659322998
Name:RUSHTON, MICHAEL JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:RUSHTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1404
Mailing Address - Country:US
Mailing Address - Phone:541-524-0122
Mailing Address - Fax:541-524-2120
Practice Address - Street 1:2830 10TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1404
Practice Address - Country:US
Practice Address - Phone:541-524-0122
Practice Address - Fax:541-524-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00321213ES0103X, 332B00000X
UT361600-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR226359Medicaid
OR226359Medicaid
ORU80587Medicare UPIN