Burlison, Russell D
Burlison, Russell D is an individual health care provider with primary practice located at 1455 E Bert Kouns Loop , Shreveport LA 71105-5634. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Burlison, Russell D can be contacted via phone (318) 798-4400.Contact Information
Primary practice address
1455 E Bert Kouns Loop
Shreveport LA 71105-5634
Phone: (318) 798-4400
Fax: (318) 798-4621
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 023583 | Louisiana |
Profile Details
| NPI number | 1073517975 |
|---|---|
| LBN Legal business name | Burlison, Russell D |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 8th, 2005 |
| Last updated | Dec 11th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073517975 | NPPES |
| Louisiana | MEDICAID | 1486540 |
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