Provider Demographics
NPI:1255751814
Name:TROY E. RUSTAD, MD, PC
Entity type:Organization
Organization Name:TROY E. RUSTAD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:612-227-8769
Mailing Address - Street 1:PO BOX 23108
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68542-3108
Mailing Address - Country:US
Mailing Address - Phone:402-420-0101
Mailing Address - Fax:402-420-9933
Practice Address - Street 1:1919 S 40TH ST
Practice Address - Street 2:SUITE 330
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5243
Practice Address - Country:US
Practice Address - Phone:402-420-0101
Practice Address - Fax:402-420-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19665207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty