Provider Demographics
NPI:1700833720
Name:RUST, PAUL R (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:RUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7595 ANAGRAM DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7399
Mailing Address - Country:US
Mailing Address - Phone:612-573-2200
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:7595 ANAGRAM DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7399
Practice Address - Country:US
Practice Address - Phone:612-573-2200
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN346692085N0904X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN300083207OtherRAILROAD MEDICARE MN
MN300001672Medicare PIN
MN300003573Medicare PIN
MN300002327Medicare PIN
MN300083207OtherRAILROAD MEDICARE MN
MN00308100Medicaid
MNF13100Medicare UPIN
MN768330OtherAMERICA'S PPO
MNHP22226OtherHEALTHPARTNERS
MN028R9RUOtherBLUE CROSS
WI300124548OtherRAILROAD MEDIARE WI
WI002504070Medicare PIN
MN10R42RUOtherBLUE CROSS
MN300002327Medicare PIN
MN9172660OtherDAKOTA CARE
WI000256135Medicare PIN
MN300001672Medicare PIN
MN300003573Medicare PIN