Provider Demographics
NPI:1871849265
Name:RUSTAD DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:RUSTAD DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:RUSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-484-6222
Mailing Address - Street 1:1919 S 40TH ST
Mailing Address - Street 2:330
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5243
Mailing Address - Country:US
Mailing Address - Phone:402-484-6222
Mailing Address - Fax:402-484-6253
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:330
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-484-6222
Practice Address - Fax:402-484-6253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty