# FRED WALLACE RUSHTON JR.

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1194825323
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | 06237 | MS | Yes |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 04/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0013429 | — | MS |
| 01 | — | 020046786 GRPCG6446 | RAILROAD MEDICARE | MS |
| 05 | — | 158101 | — | AL |
| 01 | — | P00462318 | RR MEDICARE | MS |