Provider Demographics
NPI:1841240207
Name:RUST, JEFFERY SCOTT (PA)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:SCOTT
Last Name:RUST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 S CLEARVIEW AVE STE 100
Mailing Address - Street 2:URGENT CARE EXTA
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3378
Mailing Address - Country:US
Mailing Address - Phone:480-988-9108
Mailing Address - Fax:480-813-4460
Practice Address - Street 1:641 W WARNER RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-7266
Practice Address - Country:US
Practice Address - Phone:480-722-9828
Practice Address - Fax:480-722-9831
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-08-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ1575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ764169Medicaid
AZ110650Medicare ID - Type Unspecified
AZ764169Medicaid