# SAMUEL J RUSSO DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871601542
- **Authorized official:** DR. SAMUEL J RUSSO DO (OWNER)
- **Authorized official phone:** (541) 677-6586

## Contact information

- **Practice address:** 2460 NW STEWART PKWY, SUITE 100, ROSEBURG, OR 97471-1516
- **Practice address phone:** (541) 677-6586
- **Practice address fax:** (541) 677-6509
- **Mailing address:** 2460 NW STEWART PKWY, SUITE 100, ROSEBURG, OR 97471-1516
- **Mailing address phone:** (541) 677-6586
- **Mailing address fax:** (541) 677-6509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/25/2006
- **Last updated:** 08/27/2008