Individual
DR. KERMIT RUSSELL RUST III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9300 E 29TH ST N STE 206, WICHITA, KS 67226-2183
(316) 260-6762
Mailing address
9300 E 29TH ST N STE 206, WICHITA, KS 67226-2183
(316) 260-6762
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125058810
IL
2085R0202X
Diagnostic Radiology Physician
28347
OK
2085R0204X
Vascular & Interventional Radiology Physician
Primary
04-38788
KS
2085R0204X
Vascular & Interventional Radiology Physician
MD043000
DC
Other
Enumeration date
06/30/2010
Last updated
06/02/2021
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