Provider Demographics
NPI:1952472227
Name:RUSSCHER, JULIE (DPM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:RUSSCHER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6913
Mailing Address - Country:US
Mailing Address - Phone:805-736-8818
Mailing Address - Fax:805-736-9468
Practice Address - Street 1:509 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6913
Practice Address - Country:US
Practice Address - Phone:805-736-8818
Practice Address - Fax:805-736-9468
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4446AMedicare ID - Type Unspecified