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Individual
DR. LEONARD R LARUSSA
Active
Individual
DR. LEONARD R LARUSSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD000775
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000709574E
—
GA
01
—
3274611900
PECOS
GA
01
—
POD000775
PODIATRY LICENSE
GA
Enumeration date
05/19/2006
Last updated
02/12/2022
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