Basic Information
| Provider Information | |||||||||
| NPI: | 1104890003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUST | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 STEAM PLANT RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152308070 | ||||||||
| FaxNumber: | 6154521774 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STEAM PLANT ROAD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152308070 | ||||||||
| FaxNumber: | 6154521774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 01/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 35065588 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 17226 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | Q000962 | 05 | TN | MEDICAID |