Individual
RUSSELL D BURLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1455 E BERT KOUN LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4400
(318) 798-4525
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4400
(318) 798-4525
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
023583
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1486540
—
LA
Enumeration date
06/08/2005
Last updated
10/17/2025
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