Russo, Peter Joseph

Russo, Peter Joseph is an individual health care provider with primary practice located at 2545 W Hammer Ln , Stockton CA 95209-2839. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Russo, Peter Joseph can be contacted via phone (209) 957-7050.

Contact Information

Primary practice address
2545 W Hammer Ln Stockton CA 95209-2839
Phone: (209) 957-7050
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA14699 California
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA14699 California

Profile Details

NPI number 1588729941
LBN Legal business name Russo, Peter Joseph
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2006
Last updated Apr 10th, 2015 - about 10 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 1588729941 NPPES
California Other CD069A GROUP PTAN-GREATER MODESTO MEDICAL SURGICAL ASSOCIATES

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