Provider Demographics
NPI:1609865542
Name:RUSH, JOEL (DO)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:RUSH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 NE 47TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7708
Mailing Address - Country:US
Mailing Address - Phone:954-463-3200
Mailing Address - Fax:954-463-3292
Practice Address - Street 1:1960 NE 47TH ST STE 102
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-463-3200
Practice Address - Fax:954-463-3292
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS05228207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379967100Medicaid
FL379967100Medicaid
FLE61720Medicare UPIN