Individual
DR. RUSSELL SAMUEL FILECCIA JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1453 E BERT KOUN LOOP STE 112, SHREVEPORT, LA 71105-6810
(318) 798-9400
(318) 795-4656
Mailing address
PO BOX 51008, SHREVEPORT, LA 71135-1008
(318) 798-9400
(318) 798-3894
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD.021330
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059410301
—
TX
01
—
110139881
RAILROAD MEDICARE
LA
05
—
129798001
—
AR
05
—
1677663
—
LA
Enumeration date
10/25/2005
Last updated
12/09/2021
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