Provider Demographics
NPI:1710942172
Name:DESRUISSEAU, RICHARD PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PAUL
Last Name:DESRUISSEAU
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 1:2006 FRANKLIN ST SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4551
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:256-539-5827
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL357922085R0202X
CO507842085R0202X
TN409062085R0202X, 2085R0202X
WY8987A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL196722Medicaid
AL219758Medicaid
AL197989Medicaid
AL247530Medicaid
AL51589606OtherBCBS
AL197009Medicaid
AL247397Medicaid
AL51189613OtherBCBS
AL196671Medicaid
AL198034Medicaid
TN3020207Medicaid
AL51189609OtherBCBS
AL196739Medicaid
AL247723Medicaid
AL247748Medicaid
AL248917Medicaid
AL51189608OtherBCBS
AL51189612OtherBCBS
AL198600Medicaid
AL51189611OtherBCBS
AL51189615OtherBCBS
AL51209294OtherBCBS
AL11549356OtherCAQH
AL197762Medicaid