Provider Demographics
NPI:1225140627
Name:ROUSSO FACIAL PLASTIC SURGERY CLINIC PC
Entity Type:Organization
Organization Name:ROUSSO FACIAL PLASTIC SURGERY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-930-9595
Mailing Address - Street 1:2700 HIGHWAY 280 S
Mailing Address - Street 2:SUITE 300 WEST
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2420
Mailing Address - Country:US
Mailing Address - Phone:205-930-9595
Mailing Address - Fax:205-802-7719
Practice Address - Street 1:2700 HIGHWAY 280 S
Practice Address - Street 2:SUITE 300 WEST
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2420
Practice Address - Country:US
Practice Address - Phone:205-930-9595
Practice Address - Fax:205-802-7719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12459174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty