Individual
DR. JAMES KYLE RUSSO II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
120 RUE LOUIS XIV, LAFAYETTE, LA 70508-5739
(337) 769-7779
(337) 769-7788
Mailing address
120 RUE LOUIS XIV, LAFAYETTE, LA 70508-5739
(337) 769-7779
(337) 769-7788
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
MD.206162
LA
2085R0202X
Diagnostic Radiology Physician
13254
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063363
—
LA
05
—
81183
—
ND
01
—
MD.206162
LOUISIANA MEDICAL LICENSE
LA
Enumeration date
05/16/2008
Last updated
02/11/2020
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