Provider Demographics
NPI:1548655459
Name:RUSHWORTH, DAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RUSHWORTH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6348
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-6348
Mailing Address - Country:US
Mailing Address - Phone:970-844-2865
Mailing Address - Fax:970-837-3111
Practice Address - Street 1:555 RIVERGATE LN STE B1-102
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7470
Practice Address - Country:US
Practice Address - Phone:970-844-2865
Practice Address - Fax:970-837-3111
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00696202084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty