Provider Demographics
NPI:1104890003
Name:RUST, BRADLEY S (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:RUST
Suffix:
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 1:300 STEAM PLANT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-230-8070
Mailing Address - Fax:615-452-1774
Practice Address - Street 1:300 STEAM PLANT ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066
Practice Address - Country:US
Practice Address - Phone:615-230-8070
Practice Address - Fax:615-452-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065588207RP1001X
TN17226207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000962Medicaid
TN103I295939Medicare PIN