Individual
MRS. JACQUELINE JAUDON RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5427 SW 75TH TER, GAINESVILLE, FL 32608-4413
(352) 373-0188
Mailing address
5427 SW 75TH TER, GAINESVILLE, FL 32608-4413
(352) 373-0188
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
10064
FL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME#106414
FL
Other
Enumeration date
10/18/2006
Last updated
03/14/2011
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