Individual
DR. TODD RUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 N LIBERTY ST, STE 400, BOISE, ID 83704-8704
(208) 367-3320
(208) 367-7474
Mailing address
900 N LIBERTY ST, STE 400, BOISE, ID 83704-8704
(208) 367-3320
(208) 367-7474
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
M7280
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
804236300
—
ID
Enumeration date
11/28/2005
Last updated
06/01/2010
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