Provider Demographics
NPI:1720070758
Name:RUSTIN, DOWSE D (MD)
Entity type:Individual
Prefix:DR
First Name:DOWSE
Middle Name:D
Last Name:RUSTIN
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 1:376 SCHWEERS LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-5086
Mailing Address - Country:US
Mailing Address - Phone:843-723-9456
Mailing Address - Fax:843-849-0421
Practice Address - Street 1:376 SCHWEERS LN
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5086
Practice Address - Country:US
Practice Address - Phone:843-723-9456
Practice Address - Fax:843-849-0421
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5233207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB91904Medicare UPIN
SCB919045551Medicare PIN
SCB919041548Medicare ID - Type Unspecified
SC052338Medicaid
SCB919045551Medicare PIN
SCB919049223Medicare PIN
SCP00727277OtherRAILROAD MEDICARE ID-RSFPN