Provider Demographics
NPI:1780899880
Name:GARY A. RUST, MD
Entity type:Organization
Organization Name:GARY A. RUST, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-626-4900
Mailing Address - Street 1:45 CASTRO ST
Mailing Address - Street 2:210
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1010
Mailing Address - Country:US
Mailing Address - Phone:415-626-4900
Mailing Address - Fax:415-626-4901
Practice Address - Street 1:45 CASTRO ST
Practice Address - Street 2:210
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1010
Practice Address - Country:US
Practice Address - Phone:415-626-4900
Practice Address - Fax:415-626-4901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84324174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G843240Medicaid
CA00G843240Medicaid
CAG75366Medicare UPIN