Russo, Gordon J

Russo, Gordon J is an individual health care provider with primary practice located at 120 Meadowcrest St Suite 160, Gretna LA 70056-5255. He recently has only one registered license in Allopathic & Osteopathic Physicians / Procedural Dermatology, which is considered as his primary health care specialty. Russo, Gordon J can be contacted via phone (504) 391-7620.

Contact Information

Primary practice address
120 Meadowcrest St Suite 160 Gretna LA 70056-5255
Phone: (504) 391-7620
Fax: (504) 391-7524
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X 015208 Louisiana

Profile Details

NPI number 1083612469
LBN Legal business name Russo, Gordon J
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2005
Last updated Feb 3rd, 2010 - about 14 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 1083612469 NPPES
Louisiana MEDICAID 1329495

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