Individual
GLENN GERARD RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 MEADOWCREST ST, SUITE 160, GRETNA, LA 70056-5255
(504) 391-7620
(504) 391-7624
Mailing address
600 OLIVE AVE, HARVEY, LA 70058-4456
(504) 366-5035
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
017336
LA
Other
Enumeration date
03/16/2006
Last updated
02/03/2010
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