Individual
MARK STEVEN RUSSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
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
207RN0300X
Nephrology Physician
Primary
83306
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13594
BLUE CROSS BLUE SHIELD
FL
05
—
263246200
—
FL
Enumeration date
10/04/2005
Last updated
09/11/2013
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