Provider Demographics
NPI:1215941943
Name:RUSH, JAMES ANDREW (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:RUSH
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32615 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3176
Mailing Address - Country:US
Mailing Address - Phone:727-503-6077
Mailing Address - Fax:727-725-5891
Practice Address - Street 1:34612 US HIGHWAY N 19
Practice Address - Street 2:SUITE 4
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684
Practice Address - Country:US
Practice Address - Phone:727-503-6077
Practice Address - Fax:727-725-5891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0034747207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038858100Medicaid
FLC21422Medicare UPIN
FL038858100Medicaid