Individual
RUSSELL J WARDLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
16061 DOCTORS BLVD, SUITE B, HAMMOND, LA 70403-1499
(985) 542-1334
(985) 893-9594
Mailing address
16061 DOCTORS BLVD, SUITE B, HAMMOND, LA 70403-1499
(985) 542-1334
(985) 893-9594
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
026005
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1056529
—
LA
Enumeration date
08/06/2007
Last updated
04/23/2013
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