Russell, Jeremy Lawrence

Russell, Jeremy Lawrence is an individual health care provider with primary practice located at 15790 Paul Vega Md Dr , Hammond LA 70403-1436. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Russell, Jeremy Lawrence can be contacted via phone (985) 345-2700.

Contact Information

Primary practice address
15790 Paul Vega Md Dr Hammond LA 70403-1436
Phone: (985) 345-2700
Fax: (985) 230-6653
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1196694 Louisiana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 332993 Louisiana

Profile Details

NPI number 1639808306
LBN Legal business name Russell, Jeremy Lawrence
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2022
Last updated Jun 8th, 2023 - about 2 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639808306 NPPES
Louisiana Other 1639808306 NPI

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