Individual
DR. SCOTT ANDREW RUSSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
505 NE 87TH AVE STE 301, VANCOUVER, WA 98664-1965
(360) 514-7374
(360) 514-7384
Mailing address
85182 BLUE HERON WAY, EUGENE, OR 97405-8671
(719) 243-6631
(541) 868-9306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD61007212
WA
208600000X
Surgery Physician
4748
AK
208600000X
Surgery Physician
MD163726
OR
208600000X
Surgery Physician
Primary
MD61007212
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500659745
MEDICAID
OR
Enumeration date
02/14/2006
Last updated
06/08/2022
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