Individual
DR. MARK C RUSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
(573) 202-2484
Mailing address
1050 W 10TH ST, ROLLA, MO 65401-2905
(573) 364-9000
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2013000673
MO
207Y00000X
Otolaryngology Physician
39450
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000727593
BLUE CROSS BLUE SHIELD
KY
05
—
64105109
—
KY
Enumeration date
07/07/2006
Last updated
01/29/2025
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