Individual
FRED WALLACE RUSHTON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 925-6805
(601) 926-4978
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
06237
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013429
—
MS
01
—
020046786 GRPCG6446
RAILROAD MEDICARE
MS
05
—
158101
—
AL
01
—
P00462318
RR MEDICARE
MS
Enumeration date
09/25/2006
Last updated
04/22/2014
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