Organization
NAPLES NEPHROLOGY P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK STEVEN RUSSO MD (PRESIDENT)
(239) 513-1002
Entity
Organization
Contact information
Practice address
878 109TH AVE N, NAPLES, FL 34108-1821
(239) 513-1002
(239) 513-1915
Mailing address
878 109TH AVE N, NAPLES, FL 34108-1821
(239) 513-1002
(239) 513-1915
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME83306
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
263246200
—
FL
01
—
39198
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/21/2007
Last updated
05/19/2008
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