Provider Demographics
NPI:1578787271
Name:RUSSO, COURTNEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:L
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 HOUMA BLVD STE 18
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2921
Mailing Address - Country:US
Mailing Address - Phone:504-455-0093
Mailing Address - Fax:504-454-3964
Practice Address - Street 1:3939 HOUMA BOULEVARD STE 18
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2921
Practice Address - Country:US
Practice Address - Phone:504-455-0093
Practice Address - Fax:504-454-3964
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010154207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118826Medicaid
LA5K8085B522Medicare ID - Type Unspecified
LA1118826Medicaid