Provider Demographics
NPI:1366977423
Name:RUST, SARAH ANNE (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:RUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:ORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15814 NEELEY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725-8420
Mailing Address - Country:US
Mailing Address - Phone:812-867-8991
Mailing Address - Fax:812-867-8995
Practice Address - Street 1:15814 NEELEY ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-8420
Practice Address - Country:US
Practice Address - Phone:812-867-8991
Practice Address - Fax:812-867-8995
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01083672A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program