Provider Demographics
NPI:1811908270
Name:CAIN, RUSTY LEE (DPM)
Entity type:Individual
Prefix:
First Name:RUSTY
Middle Name:LEE
Last Name:CAIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2369
Mailing Address - Country:US
Mailing Address - Phone:304-363-3338
Mailing Address - Fax:304-363-3359
Practice Address - Street 1:1228 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2369
Practice Address - Country:US
Practice Address - Phone:304-363-3338
Practice Address - Fax:304-363-3359
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00349213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6420007001Medicaid
WVU73984Medicare UPIN
WV6420007001Medicaid
WV0881062Medicare PIN