Provider Demographics
NPI:1801840806
Name:RUSH, MARK E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:RUSH
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:PO BOX 160354
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84016-0354
Mailing Address - Country:US
Mailing Address - Phone:801-774-8992
Mailing Address - Fax:801-525-0347
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1120
Practice Address - Country:US
Practice Address - Phone:801-807-7140
Practice Address - Fax:801-807-7090
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1708331205207L00000X, 207LP2900X
UT170833-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT17083312000001OtherBLUE CROSS
UT73000OtherPEHP
UTTPRA07445OtherMOLINA
UTQM0000030147OtherALTIUS
UT107018852101OtherSELECTHEALTH
UT12600OtherUUHP
UT170901OtherDMBA
UTA37638Medicare UPIN
UT17083312000001OtherBLUE CROSS