Russo, Ethan Budd
Russo, Ethan Budd is an sole proprietor health care provider with primary practice located at 20402 81St Avenue Sw , Vashon WA 98070-6253. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Russo, Ethan Budd can be contacted via phone (206) 304-4344.Contact Information
Primary practice address
20402 81St Avenue Sw
Vashon WA 98070-6253
Phone: (206) 304-4344
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 00018304 | Washington |
Profile Details
| NPI number | 1760024632 |
|---|---|
| LBN Legal business name | Russo, Ethan Budd |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 12th, 2019 |
| Last updated | Oct 12th, 2019 - about 6 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 | 1760024632 | NPPES |
| Washington | Other | 00018304 | WASHINGTON STATE MEDICAL LICENSE |
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