Provider Demographics
NPI:1124051248
Name:RUTLAND, EDWARD HAMPTON (MD)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:HAMPTON
Last Name:RUTLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 THOMAS ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291
Mailing Address - Country:US
Mailing Address - Phone:318-329-8517
Mailing Address - Fax:318-329-8518
Practice Address - Street 1:102 THOMAS ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-329-8517
Practice Address - Fax:318-329-8518
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19100208800000X
LAMD.204640208800000X
FLME104163208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCI930ZMedicare PIN