Provider Demographics
NPI:1104981208
Name:RUSHTON, STEWART JR (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:RUSHTON
Suffix:JR
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 1:1 STONE MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-2377
Mailing Address - Country:US
Mailing Address - Phone:609-466-2016
Mailing Address - Fax:
Practice Address - Street 1:1003 FRED LAGRONE DR
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-4546
Practice Address - Country:US
Practice Address - Phone:870-364-3800
Practice Address - Fax:870-364-3811
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1899207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135356001Medicaid
AR5K984F528Medicare PIN
AR135356001Medicaid