Individual
DR. RUSSELL B HENNESSEY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 S SPRUCE ST, VIVIAN, LA 71082-3232
(318) 375-3239
Mailing address
3025 OLD MOORINGSPORT RD, SHREVEPORT, LA 71107-4022
(318) 797-1743
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
022466
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1944569
—
LA
Enumeration date
06/03/2006
Last updated
07/08/2007
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