Provider Demographics
NPI:1790806578
Name:RUSH, BENJAMIN TERRELL (DO)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:TERRELL
Last Name:RUSH
Suffix:
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 1:2055 E SOUTH BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-2004
Mailing Address - Country:US
Mailing Address - Phone:334-284-6500
Mailing Address - Fax:334-284-6202
Practice Address - Street 1:2055 E SOUTH BLVD STE 503
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2004
Practice Address - Country:US
Practice Address - Phone:334-284-6500
Practice Address - Fax:334-284-6202
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.14952086S0129X
AL1495208600000X
MS19038208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08175829Medicaid