Individual
SCOTT JUSSEAUME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
450 BROOK ST, PROVIDENCE, RI 02906-2231
(401) 863-3953
(401) 863-7953
Mailing address
450 BROOK ST, PROVIDENCE, RI 02906-2231
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
216386
MA
207Q00000X
Family Medicine Physician
Primary
MD19533
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2080222
—
MA
Enumeration date
03/14/2006
Last updated
12/06/2023
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