Provider Demographics
NPI:1427210905
Name:RUSSO, LAWRENCE JUSTUS
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JUSTUS
Last Name:RUSSO
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LAWRENCE
Other - Middle Name:JUSTUS
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1430 SHELTERING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1962
Mailing Address - Country:US
Mailing Address - Phone:281-913-2475
Mailing Address - Fax:
Practice Address - Street 1:1430 SHELTERING OAKS LN
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77345-1962
Practice Address - Country:US
Practice Address - Phone:281-913-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11463207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery