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Individual
DR. JOHN L ROUSSALIS
Active
Individual
DR. JOHN L ROUSSALIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.PC
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD426938
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127068100
—
WY
01
—
W21591
PTAN
WY
Enumeration date
04/09/2007
Last updated
06/23/2021
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