Provider Demographics
NPI:1174863864
Name:TOURTSEV, ROUSLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ROUSLAN
Middle Name:
Last Name:TOURTSEV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:AINSWORTH
Mailing Address - State:NE
Mailing Address - Zip Code:69210-0287
Mailing Address - Country:US
Mailing Address - Phone:402-387-1900
Mailing Address - Fax:
Practice Address - Street 1:193 OLD SWEDE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1522
Practice Address - Country:US
Practice Address - Phone:610-385-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-18
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014999207Q00000X
NE1504207Q00000X
390200000X
PAOS020544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program