Provider Demographics
NPI:1952543811
Name:RUSSO, RUSSELL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:R
Last Name:RUSSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUSSELL
Other - Middle Name:RUBEN
Other - Last Name:RUSSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:6901 CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3407
Mailing Address - Country:US
Mailing Address - Phone:504-592-6437
Mailing Address - Fax:504-592-6438
Practice Address - Street 1:5620 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3106
Practice Address - Country:US
Practice Address - Phone:504-592-6600
Practice Address - Fax:504-592-6438
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2017-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD205273207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine