Provider Demographics
NPI:1588841589
Name:RUSTAD, JAMES KNOWLES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KNOWLES
Last Name:RUSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8440 S DIXIE HWY
Mailing Address - Street 2:APARTMENT 1405
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-7805
Mailing Address - Country:US
Mailing Address - Phone:802-999-6026
Mailing Address - Fax:
Practice Address - Street 1:8440 S DIXIE HWY
Practice Address - Street 2:APARTMENT 1405
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-7805
Practice Address - Country:US
Practice Address - Phone:802-999-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN 113332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry